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HEALING SPACES IN ARCHITECTURE – A STUDY THE EXPLORES


THE ABILITY OF SPACE TO ENHANCE HEALING

A DISSERTATION

Submitted by

Cayser Hussain H
311211251007

In partial fulfilment of the requirements

for the award of the degree

of
BACHELOR OF ARCHITECTURE

ANNA UNIVERSITY

MARG INSTITUTE OF DESIGN AND ARCHITECTURE


SWARNABHOOMI
Velur Village, Cheyyur Post

Kanchipuram District

Tamil Nadu - 603302

APRIL 2015
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DECLARATION

I declare that this Dissertation titled “HEALING SPACES IN


ARCHITECTURE” is the result of my work and prepared by me under the
guidance of Mr. Martin Laferriere and that work reported herein does
not form part of any other dissertation of this or any other University. Due
acknowledgement have been made wherever anything has been
borrowed from other sources.

DATE: SIGNATURE OF THE CANDIDATE

NAME : Cayser Hussain H

ROLL NUMBER : 311211251007


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BONAFIDE CERTIFICATE

Certified that this Dissertation forming part of Course work


AR2452, Dissertation, VIII semester, B.Arch, entitled
“HEALING SPACES IN ARCHITECTURE”
Submitted by Mr. Cayser Hussain, Roll No. 311211251007
to the Department of architecture, MARG Institute of Design and
Architecture Swarnabhoomi, Anna University, Chennai in partial fulfilment
of the requirements for the award of Bachelor Degree in Architecture is a
bonafide record of work carried by him under my supervision.
Certified further that to the best of my knowledge the work reported herein
does not form part of any other dissertation.

DATE: SIGNATURE OF THE SUPERVISOR


NAME
DESIGNATION

EXTERNAL EXAMINER HOD, MIDAS PRINCIPAL,


MIDAS
DATE : DATE: DATE:
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HEALING SPACES IN ARCHITECTURE

The arts and art therapy have, over the years, been used to heal different
aliments such as cancer, mental illness, aids, addiction and the elderly have
been successful in doing so as it heals across all ages and race.

Can architecture do the same?

How architecture can inform healing or provide spaces and events where
healing can take place?
ABSTRACT

Winston Churchill concisely expressed the effect of architecture and our


surroundings with the comment that: “We shape our buildings and later they
shape us.”

The intent of this dissertation is to explore how architecture can inform healing
or provide spaces and events where healing can take place. We as human
beings have an inner connection with our environment by physical, mental,
emotional and spiritual means. This connection can create a dynamic life that
people can thrive in every aspect. Through work, aging or learning, people are
able to participate and contribute to this connection with our environment.

Furthermore, the arts and art therapy have, over the years, been used to heal
different aliments such as cancer, mental illness, aids, addiction and the elderly
have been successful in doing so as it heals across all ages and race. The
question I pose is can architecture do the same? Besides, can architecture play
a superior role in healing? In our built environment we often interact with the
buildings themselves without realizing the great influence that such built
environments and surroundings hold. Can we create those interactions by
evidence based design methods?

Mental health has been a debated topic to centuries and still today, the
common being has not grasped its complexities that bound us all unique.This
dissertation represents an attempt to summarize my findings on the role of
planning and architecture in the healing process.

This research commence with defining, what does healing means? And then
discourse of art to study the root of the healing. I am also framing out significant
parameters that guide the design of healing spaces. To support my parameters
I am also citing the works and writing of the Architects like Juhani Pallassma,
Stefan Lundin, Peter Zumthor, Christopher Alexander, Aalto, etc.

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ACKNOWLEDGEMENTS

I would like to thank God for getting through all obstacles in my life and always

making my dreams come true. Without you all would not be possible.

To my mentor Mr. Martin Laferriere for believing in me, motivating me and

keeping me geared in the right direction. I would also like to thank Mrs. Chitra

Vishwanath and the entire team of BIOME environmental solutions for all the

guidance.

To my family for constant support in all I do, the tears of frustration and dealing

with this strong headed person called me! Thank you for moulding me into the

man I am today. Thank you Amma for always doing everything in your power to

make everything possible for me.

I am also grateful to my friends Armity, Karthikeyan, Priyanka, Ravi, Vani,

Karishma, Sai, Ragu, Mira and all other pals for always keeping me focused

and being the support I needed that has taken me this far.

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TABLE OF CONTENTS
ABSTRACT ......................................................................................................... i

ACKNOWLEDGEMENTS .................................................................................. ii

LIST OF FIGURES ............................................................................................ v

CHAPTER 1 - INTRODUCTION ........................................................................ 1

1.1 WHAT IS HEALING? ................................................................................ 1

1.2 ART: THE ANTIDOTE .............................................................................. 2

1.3 ARCHITECTURE AS A HEALING ATMOSPHERE .................................. 3

CHAPTER 2 – PLANNING PARAMETERS ...................................................... 5

2.1 CONVIVIAL ENTRANCE .......................................................................... 5

2.2 ESTEEMED ENVIRONMENT .................................................................. 6

2.3 ADDRESSING THE NORMALCY ............................................................ 8

2.4 FREE AND OPEN ATMOSPHERE ........................................................ 11

2.5 DIRECTLY ACCESSIBLE GREEN ......................................................... 14

2.6 PUBLIC SPHERE ENVELOPES THE PERSONAL SPHERE ................ 17

2.7 PROXIMITY AND FLEXIBILITY ............................................................. 19

2.8 SCHEDULING OF VISTAS .................................................................... 21

2.9 ROOMS ON THE PATIENT’S TERMS ................................................... 23

CHAPTER 3 – ELEMENTS OF HEALING ...................................................... 26

3.1 COLOUR ................................................................................................ 26

3.1.1 PRECEDENT STUDY – ALDO VON EYCK ..................................... 29

3.2 WATER................................................................................................... 31

3.3 LANDSCAPE .......................................................................................... 34

3.3.1 PRECEDENT STUDY – HEALING GARDEN .................................. 37

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3.4 MATERIALS ........................................................................................... 38

3.4.1PRECEDENT STUDY – THERME VALS .......................................... 39

3.5SUN ......................................................................................................... 41

3.5.1PRECEDENT STUDY – PIAMO SANATORIUM ............................... 43

CONCLUSION ................................................................................................. 45

BIBLIOGRAPHY .............................................................................................. 48

IMAGE REFERENCE ...................................................................................... 50

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LIST OF FIGURES
Figure 1 : Optimal healing environment chart. Terri Zborowskv

Figure 2 : Visual art as healing medium

Figure 3 : Meditation as healing medium

Figure 4 : Piamo Sanatorium, Alvar Aalto, View of Corridor

Figure 5 : Mukthangan De-addiction centre, Pune by Sirish Beri, Entrance


View

Figure 6 : Explains the balance between environment and other criteria in Peter
Zumthor’s design of Therme Vals

Figure 7 : Christopher Alexander’s Pattern for Health Care

Figure 8 : Piamo Sanatorium, Alvar Aalto, View of Cafe

Figure 9 : Piamo Sanatorium, Alvar Aalto, Exterior View

Figure 10 : Mukthangan De-addiction centre, Pune by Sirish Beri,


Amphitheatre Space

Figure 11 : Continuum Centre for Health and Healing, Patients room

Figure 12 : Piamo Sanatorium, Alvar Aalto, View of Lounge room with special
furniture

Figure 13 : Piamo Sanatorium, Alvar Aalto, View of Patient room with the
overlooking windows

Figure 14 : Piamo Sanatorium, Alvar Aalto, View of Staircase, Bright use of


colour to enhance movement

Figure 15 : Therme Vals, Peter Zumthor, Blue ambience to make the interior a
sense of coolness

Figure 16 : Hubertus House, Aldo Van Eyck, Exterior View

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Figure 17 : Hubertus House, Aldo Van Eyck

Figure 18 : Hubertus House, Aldo Van Eyck

Figure 19 : Woodwinds Hospital in Minneapolis, Barcelona, View of Water body

Figure 20 : Woodwinds Hospital in Minneapolis, Barcelona, View of an


Landscape

Figure 21 : Ayurvedic farm in Valley de Bravo, Mexico, View of Landscaped


Healing space

Figure 22 : Therme Vals, Peter Zumthor. Materiality

Figure 23 : Therme Vals, Peter Zumthor. Darkness through Material

Figure 24 : Piamo Sanatorium, Alvar Aalto, View of an entrance

Figure 25 : Piamo Sanatorium, Alvar Aalto, Patient room section, shows the
focus on light to improve wellness

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CHAPTER 1 - INTRODUCTION

WHAT IS HEALING?
Healing is the process of re-establishing harmony within the organism. Illness
implies a loss of this balance and the need for reintegration with the body’s
natural ability to heal and regenerate. Healing cannot be understood in isolation
from the factors that operate in the dynamic life of an individual. These include
the self, the family, the community, the environmental context within which life
is carried forth, and the world of spirit or essence. Healing is dependent on
restabilising successful relationships and developing reciprocity between these
factors. In fact, healing is not a process of curing or fixing, but rather a return to
balance between all of these components1. Health, therefore, is understood as
the presence of this balance; illness is its lack. Far from being inert containers,
spaces can be understood to be fully participant in the healing experience. It Is
possible to conceive and create structures that heal. Although materials,

Figure 1 : Optimal healing environment chart. Terri Zborowskv

1.Barabara,J. Huelat. Healing environments: Design for the body, mind & spirit.
Arlington, VA: Peecapress, 2003

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structure, and equipment are part of this endeavour, equal footing can be
granted to the land, the natural world, the community, our ancestors, and the
spirit in all of this. Working with the totality of these forces can result in
conscious co-creation of spaces that are not only useful, but which are vibrant
and alive, and therefore capable of their own contributions.

ART: THE ANTIDOTE


Art has always been a part of our culture, tradition and society. The human
race has evolved with some form of art within cultural practices since our early
beginnings and it seems inherent in all of us whether it is through praising of
the gods, healing or rites of passage. Yet, as evident as this may be, many
disregard the healing qualities that art possesses and the enhancement of
lateral creativity that it can bring to us. To look at art as a tool for healing we
have to transcend thresholds that rigidly bind us to the confinements of our
rational consciousness. We need to understand art beyond the traditional
technical approach of artist and canvas. We need to free the boundaries from
the terrestrial rules of art and explore the therapeutic qualities that it can
enhance in all of us.

Figure 2 : Visual art as healing medium Figure 3 : Meditation as healing medium

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The arts, whether in the performing arts, painting, sculpting, cooking or


gardening are a form of meditation where the creator is in tune with his/her
centre. In this sense, art is a spirit that one unconsciously experiences with a
sense of a healing.2

For me, art is the creation of what the soul is crying out to express. It is the
harmony that tunes the soul with what is tangible. If we are all architects of our
reality, then art is an expression of how we see ourselves within ourselves in
relation to the world around us. This means that artistic expression is personal
and it is a journey of self-discovery -much like healing. “...If Illness and health
are nouns, then healing is a verb. It is movement in a desired direction- a
journey that takes you from illness to health.”3 By this interpretation, therefore,
healing is an action: a decision one makes in search of better well-being.

ARCHITECTURE AS A HEALING ATMOSPHERE


With this in mind, I would like to explore architecture to see how art can be
used as a tool for healing. Architecture takes a holographic approach by
looking at the effectiveness of art to promote healing. It is a therapeutic
experience aimed at connecting with the inner-self to bring about change in a
person’s lived experience. The question that needs to be asked is that, if art
does have a healing effect how can architecture as an artistic science
contribute to this? Can our environments heal or can it make us sick? I would
like to explore the architecture which can be used as a tool for healing.

Healing in psychology, medicine and even nature involves a process where the
patient or the recipient receives a physically external antidote in order to help

2
Dalley, Tessa, Art as Therapy An Introduction to the use of art as a
therapeutic technique. London: Tavistock Publications, 1984
3
Strenernberg, M. Esther, Healing spaces: The science of place and well being.
Harverd University Press, 2009

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them heal. It is then up to the patient to take the inward step of acceptance and
observation in order to progress the healing.

Figure 4 : Piamo Sanatorium, Alvar Aalto – View of Corridor

However, if we ignore the qualities of physical context it could involuntarily slow


the healing process. The study published in Science magazine in 1984 showed
that when hospital wards looked out to nature the patients healed faster. It was
modernist architect, Roger Ulrich who performed the experiments that proved
that window views could affect healing. Ulrich chose 46 patients, 23 of which
had beds near windows that overlooked a landscape of trees and the other 23
looked onto a brick wall4. After studying their vital signs and their pain
medication doses it showed that the patients that were positioned by the
window needed fewer doses of pain medication and were healing at a rapid
rate than the others. This meant that hospital wards provided for treatment
facilities in the ward where medication and rest were provided for, and healing
facilities where one could relax and enjoy nature and the healthy rays of the

4
Strenernberg, M. Esther, Healing spaces: The science of place and well being.
Harverd University Press, 2009

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sun. In addition, natural sunlight and air were the most effective ways of
purifying the air and killing bacteria.

CHAPTER 2 – PLANNING PARAMETERS

CONVIVIAL ENTRANCE
First impressions matter a great deal. The first encounter deeply tinges our
further experience and thus means a very great deal. Almost instantaneously
we create for ourselves an image, not just of the building but of all its activities.
Indeed, Stefan Lundin in his book Architecture as Medicine wonders whether
the response and expectations thus generated do not make an important
difference to our own response to the care which is to follow.5

In many instances, the entrance situation has been a neglected point in the
design of healing spaces. Descriptions from the world of psychiatry testify to
obscure, shabby entrances next to loading bays and waste bin rooms. This has
the effect of degrading the patient, making him / her feel unworthy of neatness
and a decent reception, but the basic intent to make it as simple as possible for
the patient to seek care.

In Architect Sirish Beri’s


Muktangan de-addiction
centre, Pune, he disposed
transparent entrance to have
controlled flow of traffic and
the easy supervision. The
recessed entrance with the
integrated landscape and the
flight of steps give the sense
Figure 5 : Mukthangan De-addiction centre, of welcoming entrance. He
Pune by Sirish Beri, Entrance View

5
Lundin, Stefan, Architecture as Medicine– the Importance of Architecture in
Psychiatry. Architecture Research Foundation, 2010 [40]

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also housed kitchen and other services at the rear side of the site to allow
service access, without any chaos in the main entrance. From this precedent,
the coherence between the entrance and the good first impression is
interpreted.

 a good first impression


 a welcoming entrance
 an entrance for everyone
 a special entrance for emergency cases

ESTEEMED ENVIRONMENT
Frequently, a mentally ill person has a feeling of elimination combined with a
negative self-image. The patient’s self-esteem can be boosted by offering them
dignified environment with premises signalling: “OK, so you’re ill and may not
always be on your best behaviour, but help and sympathy are forthcoming from
those of us who, for the moment at least, are better off..” 6

Care must be made evident in details both large and small when designing the
premises. It is occasionally argued that many sick persons come from squalid
backgrounds should not be offered anything that seems exaggeratedly posh,
something which, not being significant of the patients’ everyday surroundings,
may feel strange and uncomfortable. But shabby surroundings are probably not
freely chosen but are the consequences of a generally disadvantaged situation.
Stefan Lundin’s ideologies are more inclined to believe that it is connected with
the actual care situation, with being looked after and having people around one
for company, people who cater to one’s need of security. Arguments are also

6
Lundin, Stefan, Architecture as Medicine– the Importance of Architecture in
Psychiatry. Architecture Research Foundation, 2010 [43]

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presented for psychiatry buildings being solidly and robustly constructed – hard
to wreck and easy to maintain. 7

Figure 6 : Explains the balance between environment and other criteria in Peter
Zumthor’s design of Therme Vals

He also questions the conventional ideas, If the environment looks to have


been designed for the prevention of damage and vandalism, then,
paradoxically enough, it seems to encourage or indeed provoke inventive
modes of destruction. We human beings behave mostly as others around us
expect us to. This also applies to people who are mentally ill. If the smoking

7
Lundin, Stefan, Architecture as Medicine– the Importance of Architecture in
Psychiatry. Architecture Research Foundation, 2010 [43]

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room has pressed-brick flooring, people will stub out their cigarettes on it. If the
room has linoleum flooring, smokers will use the ash tray. But what impression
is the environment to make – homelike, cosy? Probably professional in the
treatment situation and more cosy for caring and residence, but it can be hard
to pin down the qualities making one environment homelike or cosy. Most
often, though, a harmony of perception is not hard to find. We have also
discovered that it is possible, and fruitful, to use character concepts of this kind
in the dialogue between operation and architect.

Peter Zumthor in his design of Therme Vals, maintained the balance between
the materials and the environment to emphasise the relationship with the
nature, while de-emphasizing the sense of sight in favour of the other senses.
“Recalling Michael Weinstock’s work “Nature and Civilization,” it is clear that
while on one hand the baths may be seen as an example where humans
harness nature, at the same time nature is celebrated, thus revealing a
harmonious human-nature relationship.”8 This way of balancing environment
and material to revitalize mental illness is defined as dignified environment.

• a dignified environment
• carefully designed spaces and attention to details
• people behavioural pattern
• cosy accommodation
• Watch out for day-to-day dilapidation

ADDRESSING THE NORMALCY


Normalcy should be the main objective if the architecture is aimed for healing.
This attempt should permeate the whole of the design process, from
overarching zoning to the tiniest detail. The normal is what is recognisable and
familiar. It is the normal – the healthy – side of the patients which has to be

8
Zumthor, Peter. Thinking Architecture. Lars Müller, 1998. Print.Hamish
Hamilton, 2006. Print.

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encouraged and supported. The skills people have lost or have never had must
be developed so that the patient will not relapse into apathy.

Certain patients have a low functional level and inadequate social skills. This
being so, it is essential to create routines for such everyday occupations as
personal hygiene, laundry, cleaning and cooking and to provide a functional,
pleasant solution for them. It seemed especially important to highlight the
sensual qualities and social atmosphere of mealtimes. For this reason too, staff
and patients should eat together – a sometimes disputed tenet. Maintenance of
these everyday routines is most important to persons who will be staying for a
long time and who have got over the most acute stages of illness but, for some
reason, are still being detained. If institutionalisation is what we seek to avoid,
then normalcy is what we have to look for.

But what exactly is normalcy? The term can be framed in a variety of ways.
What we normally mean by normal is, I suppose, normally interpreted quite
broadly. Stefan Lundin characterize normalcy as, “Often we perceive a wide
span of behaviours or attitudes as normal. Perhaps the word “normal” can also
express what a psychiatric environment is not to be. It must not be a hospital, a
prison or an institution – to quote the imagery often employed with reference to
psychiatric care.9 Pursuing the distinctive atmosphere of the hospital or
penitentiary does not feel natural. But where the hospital is concerned, surely
what we want to avoid is not the care situation itself but its frequently bare and
none too cosy physical setting? The concept of nursing includes the feeling of
care and security, which is intrinsically positive if it refers to a brief period
during which one is in need of support. Correspondingly positive associations
are harder to find in the concept of criminal welfare (“prison care”), even though
the requirement of social protection is a valid one. Finally, the term “institution”
seems to have various connotations, not all of them pejorative. Some maintain

9
Lundin, Stefan, Architecture as Medicine– the Importance of Architecture in
Psychiatry. Architecture Research Foundation, 2010

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that the expression conveyed by the building must in fact be that of the
institution – society’s expression of its exercise of authority.

Moreover, Christopher Alexander in his book, A pattern language expressed


“the explicit recognition of the life cycle as the basis for every individual life will
do a great deal to help people's health in the community life cycle; this pattern
describes the more specific institutions which help people to care for
themselves and their health. More than 90 per cent of the people walking about
in an ordinary neighborhood are unhealthy, judged by simple biological
criteria.”.10

In this he criticise the health


care that tends to create
sickness rather than haling
that. A system of space that
is capable of keeping people
healthy, in both mind and
body, must put its emphasis
on health, not sickness. So it
Figure 7 : Christopher Alexander’s Pattern for
Health Care must be physically
decentralised, to encourage
people in daily practices that lead to health, otherwise this ill health cannot be
cured by hospitals or medicine.

• aim for normalcy


• avoid institutionalisation
• characterise everyday occupations

10
Alexander, Christopher, A Pattern Language. Oxford University press. 1977

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FREE AND OPEN ATMOSPHERE


One of the very foremost challenges the architect has to face is that of “creating
a free and open atmosphere” – which again is a proposal to achieve something
which will feel normal. In some cases the desiderata presented by psychiatry
are downright self-contradictory. The desire for a care unit which will be
experienced as open is coupled with the need for a care unit which will be
closed and locked. The desire to give the patient an identity of his / her own
and the ability to choose, for example, between seclusion and sociability, is
coupled with the staff’s need to know the patient’s position.

Mental care has elements of coercion – unavoidably so. The patients often
spend time in a locked care unit and temporary coercive measures occur in the
form of isolation,
medication and shackle
restraint. The safety of
society – that is, the
safety of citizens –
requires certain
patients to be kept
under lock and key and
escapes to be
prevented, because
certain patients can
turn violent. Other
patients, like the staff,
also demand protection
from patients with
acting-out behaviour
within the care unit
itself, added to which,

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patients need in certain cases to be protected from their own self-destructive


behaviour, the ultimate consequence of which is attempted suicide. The
smuggling in of drugs is another major problem. Nearly half of all psychiatric
patients have a dual diagnosis, i.e. a substance abuse problem on top of their
mental illness.

All the things that have now been listed are realities which cannot be
overlooked. Psychiatric work involves a constant intersection of the care and
security perspectives. The issues which the department has to take a stand on
are very complex and complicated and are a perpetual source of discussion
and disagreement, but they occupy a central and quite crucial position in
discussions concerning the design of the facilities. If the security perspective
has the last word in everything, we risk ending up with a “prison environment”,
with all the negative associations and provocations this implies. In their physical
form, should be concealed or anonymously designed.

As stated by Pallasmaa ”Aalto wanted to lessen the strain between the client
and the interior environment he was living in, especially concerning the
technology in the space.” 11. Alvar Aalto in his design of Piamo Sanatorium,
concentrated more on creating social environment with the view of seclusion by
proposing each wing oriented in the direction optimally required by its function.
At the same time, rooms with the same requirements were grouped together in
their own wings. Separating functions was also favourable from the point of
view of seclusion. The aim of getting natural light into the rooms from a
favourable direction was also achieved. A single building, on the other hand,
Figure 8 : Piamo Sanatorium, Alvar Aalto, View of Cafe offered other advantages compared to a
design solution where each function has its own completely separate building:
in the former, efficiency and internal connections were improved.

Associations with coercion and power should if possible be avoided so as to


counteract the institutional stigma and encourage normalcy. In this way we try

Pallasmaa, Juhani. The Eyes of the Skin. Great Britain: John Wiley and Sons,
11

2005

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to avoid constantly reminding the patients of their plight, of the potential threat
they are judged to constitute – resulting in self-reproach, feelings of
claustrophobia and so on. Paradoxically enough, one sine qua non of being
able to create a free and open atmosphere is a simple, unconstrained way of
maintaining necessary control. With more numerous and spacious facilities,
with separate rooms to live and perhaps access to a garden of one’s own, this
surveillance, generally speaking, is harder to maintain, and so it is of the utmost
importance to create concentrated care units with great proximity and a good
overview. The often highly specialised facility programmes which are initially
desired for the activities should be thoroughly penetrated. A high level of facility
pooling is proposed. If the layout is organised in such a way that certain parts
can be closed, this is an advantage, not least in the evenings, when there are
fewer staff on duty.

The design of the care unit station is one instance of what we mean by “not
reminding the patients of their plight”. The station must not be designed like a
ship’s bridge or a watch tower where the staff sit looking out over the care unit.
The staff must for the most part be “out in the field”, directly accessible to the
patients. But openness to the care unit station is nonetheless desirable when
the staff actually need to be able to withdraw and get on with certain tasks
more undisturbed. An open door and a glass partition can give the desirable
sense of relative seclusion, while at the same time affording a certain overview
or sense of what is going on in the care unit. The patients for their part are
given a certain insight so that they are apprised of the staff’s whereabouts. The
knowledge of being seen brings security to certain patients. This dual wish for
outlook and insight also applies to several other premises. We believe that
large glazed sections in rooms where patients are present work excellently if
they are provided with adjustable seclusion safeguards, which often include
bright, airy curtains. In this way both openness and seclusion can be obtained,
depending on the activities in progress. With the contemporary technologies
manufacturing large, shatter-proof panes of glass for which no protective
“prison bars” are possible.

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Excessive soundproofing in relation to receptions, care unit stations and


consultation rooms and clean utilities has in some cases proved a security
problem, due to the staff being unable to hear if anything special is going on in
the care unit, which deprives them of the sense of overview and control.
Sounds can also be sophisticated signals setting up unwanted associations
and arousing traumatic experiences. Rattling keys are a classic of this kind in
the context of psychiatry. For this reason it is desirable to minimise the number
of locked doors. In the design of lighting, lamps must be safe and robust
without being seen as clumsy or factory-like. Alarm and call systems should be
designed so as not to be conspicuous and dominant when not in use. Can
perhaps certain systems such as engaged-wait-enter be dispensed with
entirely? There are patients in compulsory care and patients with certain types
of diagnosis who set the level of security and escape prevention measures of
different kinds. One point to consider, then, is whether there may be cause to
have the patients with the severest illnesses in special care units, so that other
care units can be kept entirely open. This in turn begs the question as to
whether the general design of the care units, whatever the patients’ diagnosis,
has been properly thought through.

• a free and open atmosphere


• avoidance of associations with power and coercion
• overview
• address every separate facility
• beware of acoustic requirements
• use large expanses of glazing and curtains adjacent to areas frequented
by patients

DIRECTLY ACCESSIBLE GREEN


Nature has a rehabilitating effect on all of us, included the people with mental
illness. This insight appears to have grown of late, among other things because
rehabilitation in a natural setting has proved highly successful in connection

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with fatigue depressions. The subject is being intensively researched at


present. Carina Tenngart Ivarsson’s article in the present anthology also delves
deeper into the issue. Prison inmates and persons in compulsory care are
entitled by law to be allowed outdoors for at least one hour every day. At
Lillhagen this kind of outdoor access was offered in the park or on a very
inhospitable roof terrace where the patients had to be escorted by staff12.

Being outdoors endows a confined person with many positive benefits. They
can go off by themselves, get away from other patients and achieve the
seclusion they want. A patio also multiplies opportunities of movement. The
uneasy “wanderer” can move more freely so as to experience greater personal
liberty and so as to cause less irritation to others by his / her constant to-and-
fro. The possibility of moving about, feeling space and breathing one’s fill of
fresh air or having a smoke alleviates the sense of confinement and increases
the possibility of physical activity. The changes of the hours and seasons grow
more palpable. Stefan Lundin express the healing power of nature as,” Cold of
the winter, the warming influence of the spring sunshine, the gentle pattering of
a summer, rainfall. the first snowdrops and the cherry blossom, the fragrance of
lilac and the tilth of autumn, apples and vegetables, the joy of growth and
harvest. Opening the door or one’s own window to hear the blackbird singing.
The qualities are manifold and composite. Intermittently, perhaps, one contrives
to “escape” from the care unit and one’s illness.”13A garden makes a difference!
But there are also other ways in which we can absorb the qualities of nature.
Views from individual rooms and social areas, but also from corridors, help to
achieve healing. Windows which can be opened give us birdsong and natural
fresh air. The question is how far these arguments can be taken. Can the good
qualities of nature also act through natural materials? Through the polished
stone of the floor, through the oiled planks of the oak flooring, through the

12
Huelat, B. Healing environments: Design for the body, mind & spirit. Arlington,
VA: Peecapress, 2003
13
Lundin, Stefan, Architecture as Medicine– the Importance of Architecture in
Psychiatry. Architecture Research Foundation, 2010

15
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stained veneered panelling of the walls, through the birch of the handrails
through the inherent sensuality of materials? Alvar Aalto’s Piamo Sanatorium,
brings out the idea of rehabilitation by accessing the green, framing views with
well lit and ventilated spaces. The main building has been organised into five
independent entities: the main entrance, the patients’ rooms, the communal
rooms, the operating theatre, and the kitchen/ maintenance. Each activity has
its own wing, with each oriented in a direction most favourable to the activity in
question. Those rooms or groups of rooms that have similar requirements with
regards to, for instance, natural light and views, have been placed together.
This planning principle has produced a building which is naturally organised
into parts, each with a different character and orientation, offering a dynamic
whole with varying views outwards into the landscape. Despite its size, the
building does not come across as crushingly large.

The building is
dominated by a 7-
storey patient wing,
the tall and narrow
west facade of which
forms the accent point
for the whole area.
The glazed lift shaft of
the narrow west
facade is a reflection
of the Aalto’s
Figure 9 : Piamo Sanatorium, Alvar Aalto, Exterior View admiration at that time
for the machine age and modernity. The horizontal strip windows of the north-
west façade facing the entrance forecourt reveal the side corridors behind
them. Even though the external facades are white, due to the different
colouring of the corridor walls on each storey of the north-west facade, when
the internal lights are on at night time the windows form distinct different
coloured strips of light. The orientation of the wing allows an abundance of

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morning sunlight to reach. Aalto also designed for the hospital grounds to the
south of the patients’ wing a serpentine path linking a series of water fountains,
where patients could take walks. Some of the water fountains have been
preserved as flowerbeds. The path network itself is presently overgrown. The
path and pond basin system was a unique composition which both spatially and
visually linked the patient sun balcony wing and the adjacent exterior space.
Furthermore, it had an essential role in rehabilitating the patients.

• access to a garden within the care unit


• a view of natural surroundings and landscape
• windows that can be opened
• use of natural materials

PUBLIC SPHERE ENVELOPES THE PERSONAL SPHERE


Giving the possible privacy with some social spaces are necessary and are
stated as a basic qualification of rapid recovery. But constant withdrawal and
always keeping oneself to oneself so as to be spared social contacts and
confrontations is often one of the symptoms of mental illness, and so care is
concerned with developing the patient’s social capacity.

The social element also has to be gradually stepped up, but of course
depending on individual circumstances. The design of the physical
environment, accordingly, must underpin the individual patient’s gradual
enlargement of his / her personal sphere. From the patient’s own bed to the
open door, to dropping in on the person in the next room and sitting down in the
social corner to talk. Moving out into the social areas, going to the care unit
station or having a cup of coffee. Joining in meals and communal activities,
going for talks with a social worker or doctor. Meeting a relative in the café.
Going on a tour of the hospital campus. All this in order, step by step, to
acclimatise oneself to a progressively widening social context.

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Architecture must allow for and support every such step. Seclusion is a concept
which can also be used when we architects talk of the communal spaces.
There we should shape the rooms, or shape “rooms within the room”, make
small niches or seating areas of varied character where people can “take a
pew”. 14Normally speaking, mentally ill persons have a larger bubble of
personal territory. But the places created must still make people feel
encompassed and secure. These places must entice the patient, step by step,
into a social context. Some compare it to the position of prehistoric man on the
borderline between the seclusion of the forest and the openness of the
meadow, looking and wondering: what’s happening, what’s going on? The
hereditary desire for control of one’s surroundings and for feeling safe and
secure. Listening in on a conversation, watching other people playing games
and so on, may facilitate the taking of simple steps – encourage social
interaction. These places can also be described in terms of public and private.

In the care unit with the door ajar, you are in your own private sphere. In the
residential unit’s social corner you are part of a small community together with
those nearest you, in a semi-private or semi-public zone. In the middle of the
care unit you take part in the care unit’s activities, in an open and more social
context – in public life.

Huelat, B. Healing environments: Design for the body, mind & spirit. Arlington,
14

VA: Peecapress, 2003

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During my visit to
NIMHANS,
Bengaluru I observed
that patient rooms
are zoned near open
spaces with the
natural elements like
trees, sunlight and
gentle wind to heal
their agitation. The
language of making
Figure 10 : Mukthangan De-addiction centre, Pune by public activity inside the private spaces
Sirish Beri, Amphitheatre Space
are done also in Mukthangan
rehabilitation centre with the help of well lit amphitheatre space in the centre
enclosed by rough wall to give those agitated people a sense of protection.

 social participation and elective seclusion


 successive expansion of the personal sphere
 parts with different degrees of seclusion and publicity
 secure and intimate seating areas on the fringes of the public zone

PROXIMITY AND FLEXIBILITY


Stefan Lundin defines, “The heart corresponds here to the desire for a
concentrated care unit in which all the most important facilities are “near” and
“in the middle”. All activities of interest to the patient must be based there. An

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obvious centre where everyone knows what is going on and where anyone
wishing to do so can take part in activities and social gatherings. “15

Figure 11 : Continuum Centre for Health and Healing, Patients room

A strategically positioned care unit system connected with this point, of course,
are activity rooms, the TV, lounge, and an open dining area and kitchen with
generous serving spaces for a breakfast buffet, lunch and coffee. In this
periphery of the heart, and in keeping with our previous argument, care should
be devoted to creating intimate, cosy and secure places for the patients where
they can observe what is happening and, hopefully, be induced to join in
communal activities. From a caring perspective, care units with a limited
number of patients are a desideratum, but this normally comes up against
funding constraints. A good solution may then be to divide the care unit up into
smaller groups of 3-5 patient equivalents each. A unit of this kind will then be
the smallest social unit, a part of relative quiet. A communal, semi-public
common room, possibly with a pantry of its own, will also be linked to a smaller
group of this kind. In such a unit, sometimes rather formally termed a care
module, patients with similar diagnoses can be brought together. The unit can
also be used for separating certain patients from each other or for excluding

Lundin, Stefan, Architecture as Medicine– the Importance of Architecture in


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Psychiatry. Architecture Research Foundation, 2010

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someone from the communal parts. The care load varies from time to time in
the various care units. Solutions whereby one or more rooms could be added to
the different care units for a period of time would represent a substantial
efficiency gain. This, originally, was one of the main points of departure for the
architectural design of the care unit, but unfortunately we architects did not
succeed in combining this with other important programme desiderata, and so
solutions of this kind were gradually edged out.

• look for the natural midpoint – the heart


• break the care unit down into smaller units of 3-5 patient equivalents
• create a social space for each unit, possibly complete with a pantry
• facilitate a limited degree of screening-off
• vary the care unit size by attaching rooms to different care units

SCHEDULING OF VISTAS
There is a boundary where we feel that someone has got too close to us, a
boundary which is individually and culturally defined. We back away or repel
the stranger. Alan Botton in his book Architecture of happiness says, “To the
mentally ill person, this territorial bubble is for the most part far bigger than for
healthy persons, and violation of it is experienced as more threatening,
especially by people in psychotic states. This infringement of seclusion then
leads more often to stress and outbreaks of aggression, resulting in threats and
violence. It benefits neither the tranquillity of the care unit nor the healing
process in the individual.” 16Thus areas should not be so small that people “trip
over each other”. Narrow passages and corridors can be a problem. One must
be able to step aside if one wants to. Dead ends should if possible be avoided.
A second rat run is always welcome. The care unit without corridors is a dream.
During the implementation of a construction project there often comes a phase
when construction costs are penetrated. Are there no “surplus” areas which can

Cooper Marcus, C. and Barnes, M. Healing Gardens: Therapeutic benefits


16

and design recommendations. New York: Wiley, 1999

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be deleted without important qualities being lost? The quantity and size of the
patients’ social areas are often the first thing to be called into question. It can
also be tempting to reduce corridor widths, so as to be spared economising on
what one feels are real functional spaces elsewhere. But this way danger can
lie. Knut Bergsland argues that the swell factor – that is to say, the size of the
ratio between programmed area and actually built area, seems often to be a
very accurate gauge of how a facility is perceived. A large swell factor is
equivalent to a good care unit, a small swell factor to a bad one. Is this perhaps
the true yardstick of the functioning of a good or not-so-good care unit? The
fact of the patients being locked in and many of them being in compulsory care
makes views of the surroundings very important.

For this reason, certain corridors in the Piamo sanatorium have rooms on one
side only and glazing overlooking landscapes on the other side. This of course
leads to lower area efficiency, as has been remarked on and queried by
persons outside the project. But openness and vistas are space demanding,
and make the room spacious. Stefan Lundin says, “I believe intimacy is also an
important thing to achieve
for mentally ill patients.
Finding secure cosy
corners, for example by
watching the twilight from
the window embrasures of
the residential rooms.
Some of the common
rooms in the care modules
are so large that one or
two care units have

Figure 12 : Piamo Sanatorium, Alvar Aalto, View of


Lounge room with special furniture

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installed table-tennis tables in them.”17

• territory is space-demanding
• offer the wanderer a round tour
• offer a rat run, avoid dead ends
• beware of narrow corridors
• aim for a care unit without corridors

ROOMS ON THE PATIENT’S TERMS


The room in which a patient lives is their first real abode in their encounter with
in-patient care, a place which should as far as possible be governed by the
patient’s preferences. At the same time, this is the place where the patient is
most left to his / her own devices, even though suicidal patients are never left
unsupervised. The need for preventing self-destructive behaviour is also at its
greatest here, at the same time as demands for a cost environment free from
associations with force and power are more important than elsewhere. In the
room the patient can find seclusion if he / she wants it. They should be able to
lock the door behind them. A patient desiring company must be able to receive
other patients or staff members to talk to. But all this must proceed on the
patient’s own terms, according to his mood and wishes. Planned talks must
normally take place in one of the consultation / therapy rooms.

The room should be designed and furnished so as to be suitable for more than
just rest and sleep. Perhaps with a writing space, an armchair, and space for a
few people to sit round a table. The bed should be positioned so that the
patient can look out of the window, even if this means the staff not being able to
see the patient’s face directly when he / she enters the room. The size of the
room should be limited. Installing an extra bed should not be easy. That way,
we thought, we could avoid building in a potential for oversubscription. But at
the same time, in reality, this makes it impossible for family to stay the night

Lundin, Stefan, Architecture as Medicine– the Importance of Architecture in


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Psychiatry. Architecture Research Foundation, 2010

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and for doctors to allow certain flexibility in the number of patients admitted.
Can patients themselves exercise control over their immediate surroundings? If
not, stress and feelings of insecurity may ensue. Can one open the window if
the room is too warm or too cold, can automatic sun-screening be dispensed
with or can the patient control it directly if it is needed? Can the lighting be
varied? All these questions should be answerable in the affirmative. And control
of lighting and heating, for example, must be possible by simple means, so as
not to cause irritation – this is important. If sprinkler heads and ventilation grilles
etc. be more discreetly designed, this will reduce the risk of reactions from
people in psychotic or manic states. Possibilities of controlling one’s own
surrounding also include the possibility of opening one’s own window, but
openable windows are beset with great complications regarding the smuggling
in of drugs and blunt instruments. Black-out arrangements and sun screens are
also a problem.

The smuggling problem can be partly overcome by making the windows


lockable and keeping them locked for a longer or shorter period of time in
certain rooms or entire care units. Shackle restraint of patients who are judged
dangerous to themselves or others is never intended to take place in the
patient’s room. As we see it, a traumatic experience of this kind should never
be associated with one’s own room, but we have been gainsaid on this point, in
that staff from other facilities claim that patients find shackle restraint less
traumatic if it takes place in their own rooms. The surroundings are then
familiar and seem less frightening. The risk of suicide is of course greatest in
the patient’s own room, when he or she is alone. But what measures should be
taken? Is it appropriate, for example, to use special doors with concealed
hinges to eliminate the possibility of a patient attaching something to it with
which to hang himself or herself? For several reasons, I do not think so. This is
contrary to the desire for a normally designed environment and a free and open
atmosphere. Specially designed hinges can almost be experienced as a
provocation. Unfortunately, the possibilities of hanging oneself are far more
numerous and are not confined to door hinges. Door handles, wash basins and

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radiator pipes can serve the same purpose and those really intent on taking
their lives can show great ingenuity. No suicide or accident is acceptable,
however. Fixed hooks should of course be avoided. So should leads, care unit
robe bars and shower hoses capable of triggering a sudden impulse on the part
of a depressed person. Hooks must “fall down” when heavily loaded; shower
hoses should be replaced with nozzles let into the wall, and so on.

Figure 13 : Piamo Sanatorium, Alvar Aalto, View of Patient room with the overlooking
windows

In Alvar Aalto’s Piamo Sanatorium, rooms are designed based on the type of
user who is using the space. The intricate detail of the room interiors and the
products used give them the cosiness but at the same time to avoid vandalism.
The glazed surface on the south side of the room brings in the diffused light to
give those patients the enough radiation required for healing.

 patient’s preferences must be paramount in his / her own room,

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 rooms and cupboards must be lockable,


 take a close look at safety aspects of the patient’s room, from the
viewpoint of both patient and staff,
 plan for more activities than just lying in bed,
 take the view into account and try to use windows that can be opened,
 support the patient’s need for control of his or her immediate
surroundings.

CHAPTER 3 – ELEMENTS OF HEALING


COLOUR
The thoughtful reader must have observed that thus far I have avoided
touching on the department’s vision “Colour and design promoting healing
processes”. That statement greatly perplexed me on the level of principle, and
continues to do so. What is it that has colour and design and promotes healing
processes? An appealing exterior, direct communication routes, small-scale
building development, sheltered patios and so on in a never-ending flood of
questions? But, does not everything have a design (shape) and colour? Surely
these are properties which all architecture possesses, from detail to entirety,
from door handle to façade? After all, you don’t first design or construct a
building and then tack on the colour and shape of it!

Stefan Lundin states, “The Anthroposophical movement at Järna, on the


outskirts of Södertälje, Sweden, has long been a guiding star in matters of care.
There the ideas of Anthroposophy have been translated into buildings as they
were originally worked out by the founder of Anthroposophy (and of the Waldorf
education method) Rudolf Steiner and as they have been interpreted by the
Asmussen architect practice. The buildings are an inspiration both to psychiatry
and to me as an architect. The department went on a field trip there during the
programming phase, and as an architectural student I went there a number of
times in the 70s. The Eurhythmics room with its pink-stained wooden panelling,
the truncated high room volume, the skylight and the coconut matting on the

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floor were included in our reference pictures. The treatment rooms were made
to illustrate questions of lighting, bed positioning and vista. I have wrestled with
the architecture of Anthroposophy, and
have had mixed feelings about it. I am not
learned in its theory but am cautiously
sceptical nonetheless. At the same time
the architecture as such has an alluring
force in what I see and experience, and I
do not believe my impressions are
essentially different from those gained by
the people from the Psychiatry
Department. Here is something which
intuitively appeals to us and which I
believe the department partly tried to pin
down through its desideratum of colour
and design promoting healing
processes”.18 A little more exactly, this
could be put as follows:

Lundin, Stefan, Architecture as Medicine– the Importance of Architecture in


18

Psychiatry. Architecture Research Foundation, 2010

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• the architecture is different: it


has an intrinsic value and is
strongly creative of identity,
• it is expressive in details, rooms
and exterior alike,
• the materials are sensual –
beautiful to see and touch; the
intrinsic materiality of the wood
and concrete is palpable,
• the colours are often bright,
applied in several coats and
stained over; the surfaces make a
shimmering or patinated
impression,

Figure 14 : Piamo Sanatorium, Alvar Aalto, Figure 15 : Therme Vals, Peter


View of Staircase, Bright use of colour to Zumthor, Blue ambience to make
enhance movement the interior a sense of coolness

• the buildings possess simplicity and austerity, at the same time as great
care and refinement has gone into the detailing,
• use of daylight is primary, resulting in narrow volumes and well-lit rooms,
• the care devoted to lighting is unmistakeable: the lighting strengths are
low in relation to present-day medical care; the light is sparing,
sometimes verging on darkness,
• only warm filament bulbs are used, never fluorescents,

Colour often has different meanings to different cultures and is an immensely


evocative medium, possessing powers to provoke immediate and marked
reactions in the viewer. Its use in the architectural field dramatically affects
everyone’s perception of architectural space and form. Even in western
societies, the meaning of various colours has changed over the years. One of
the biggest issues with colour is that each person reacts differently based on
their culture, gender, and own personal experiences, and it has always been

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one of the most unpredictable areas within the built environment. According to
Harold Linton in Colour in Architecture “Almost any generalization that can be
made about colour can be overturned in practice.”19 There is power in colour.
Each colour has ability to affect architectural planes which allows it the power
to accentuate shapes and forms. Also it can contradict the true form and
expression the building wants to be. Colour can imply proud architecture or
display the building as abstract art. With the many applications of color, it has
the power to change our environment to make a connection with our
environment, body, mind, and spirit. Leonardo da Vinci believed that the power
of meditation increases 10 times when done in a purple light, as in the purple
light of stained glass.20

While some colours aid the mind others, green for instance, helps to build
muscles, bones and connective tissue. It even has a cooling, soothing and
calming effect on individuals, both physically and mentally. It does so through
the sympathetic nervous system by relieving tension in blood vessels which
then lowers blood pressure. Nonverbal activity is influenced by the colour violet
and is often associated with religious and spiritual issues. The slightly different
colour purple affects the brain and central nervous system. In doing so it
promotes health, creativity, inspiration, mental balance and also supports both
artistry and spirituality.

PRECEDENT STUDY – ALDO VON EYCK


Architect, Aldo Van Eyck was born in Driebergen, Holland in 1918. He was
educated in England and was known as a ‘humanist’ in the architectural field.
One of Van Eyck’s great works is the Hubertus House, a home for single
parents and their children, completed in 1978. It was designed as a multi-family
housing project done in the architectural style of the Dutch Structuralist

19
Linton, H. Color in architecture: Design methods for buildings, interiors, and
urban spaces.New York, N.Y.: The McGraw-Hill companies, Inc.. 3, 1999.
20
Ott, J. Light, radiation, and you: How to stay healthy. 22-30, 1992.

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Modern. A six-story complex designed “for their own sake and cheerfulness.”21
In other words he designed the compound as a healing environment for
families. When describing the Hubertus House Van Eyck said, “It is concerned
with the spirit and the establishment of a comfortable scale for the building of
this type and size-an open 'home' for single parents and their children-with the
creation of a non-stressful environment, in a block that seems to say 'house'.”
22Van Eyck was adamant about everyone, especially the children, having more
than just a balcony for light. He designed the new building into the old, tucking
it back and stepping back volume floor to floor, allowing fresh air and sunlight to
penetrate space. Not only was the light very important to Van Eyck but colour
as well. “Yes the rainbow sets me off! … the particular beauty of two adjacent
colours has always lured me…don’t ask for a rainbow – fetch it!” Van Eyck
said. The spectral colour was carefully laid out in the building. To insure that
the colours were to neither abrupt nor gradual, Eyck chose 12 colours; two
violets, three blues, two greens, two yellows, one orange, and two reds. Upon
arriving at the building an individual is flooded by the brilliant spectrum of
colours organized to bring immediate excitement and cheerfulness to both child
and parent. The spectral colours were carefully laid out with the blues on the
left and right-side of the building then to the bays with green. Blues and greens
are more soothing, calming colours and were carefully placed to be the first
colours they would see. Once they went inside their apartment, the colours are
just details, left as reminders of that excitement and cheerfulness they have
upon arriving at home. The colours are not overwhelming on the interior
especially where the old building links to the new. They are there to provide
and an element of colour as a decorative note. The partially spectral tiles (red-
orange-green-yellow- blue) with mirrors all around are repeated on the interior
in the water closet, reducing the width, forming a narrow strip. Between the
road and the water closet, “the intensity changes but not the scale.” Which

21
Van Eyck, A. Aldo Van Eyck works compilation by Vincent Ligtelijn. The
concerned authors and THOTH publishers, Bussum, Netherlands. 1999
22
Sharp, D. Twentieth century architecture: a visual history, 1994

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shows that “only Alice, after all, grows bigger and smaller in turn.” Or in other
words everything around us is expanding and contracting, things are too big or
small, but the building itself is always constant and there. This small detail was
designed to instil hope and security to the parents and children in order to
create a positive healing environment. There are even moments of curiosity
that Eyck developed for the children. He designed downward curving glazing in
certain areas to be at the right height for a child to peer into the next space. All
in all there is an explicit and thoughtful compilation of colour in architecture
creating an atmosphere of a healing environment for all within the Hubertus
House’s walls.

Figure 16 : Hubertus House, Aldo Figure 17 : Hubertus Figure 18 :


Van Eyck, Exterior View House, Aldo Van Eyck Hubertus House,
Aldo Van Eyck

WATER
Huelat, writes about the importance of water as, “Water is symbol of the vitality
in life and is a key to the sacredness of a healing architecture. Water can be
metaphorical of peace, tranquillity and calm. Conversely, it is also associated
with vitality, fertility, abundance, fluidity and movement. Water opens up the
contemplative nature of the soul and helps to elicit memories and a sense of

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belonging. Because water is a feminine energy, it is also associated with the


land and with the genius loci”.23

Figure 19 : Woodwinds Hospital in Minneapolis, Barcelona, View of Water body

Water helps to distribute vital sheng chi throughout the landscape, both as
surface rivers, creeks, and lakes, as well as in underground streams. This force
can be tapped by enhancing naturally occurring water in site planning of by
introducing it into the site or the structure in gardens, water features, and
vistas.

Huelat, B. Healing environments: Design for the body, mind & spirit. Arlington,
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VA: Peecapress, 2003

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Surface water has


the ability to
enhance both
healing and
prosperity, provided
it is located on the
proper direction in
relation to the
building and the
site. Geomantic
practices the world
Figure 20 : Woodwinds Hospital in Minneapolis, Barcelona,
View of Landscape over (such as feng
shui) refer to ideal locations for water in the landscape. Surface water can be
incorporated into a site in many ways: as a gushing stream in a fountain it is
symbolic of the life force, of surmounting obstacles, and initiating new life. As a
slow moving, meandering stream or creek, water is symbolic of the river of life
and our personal life path, and is also symbol of progress and attainment. As a
waterfall, it is symbolic of a leap into the unknown, of courage, and triumph
over fear.

As a still pond, water is symbolic of contemplation, of the soul’s yearning for


truth, renewal and healing. Water that disappears into the earth, a cave, or
crevice is allegoric of the cycles of life and death and can be a reassuring
symbol of our ability to overcome even the direst circumstances.

Adding a bridge over moving water is a powerful symbol of our ability to


overcome obstacles. It also helps to define our journey within the landscape
and to create a sense of natural transition into more pristine environments.

Underground water (rivers, aquifers) have the potential to greatly augment the
healing power of a site. These can be reliably located by dowsing. Dowsing is a
time-honored skill which allows its user to perceive energies such as

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underground water despite the fact that they cannot be seen. Experienced
dowsers can locate underground water on site or remotely using maps.

Water that rises towards the surface from below the site is particularly
beneficial. If the water does not break the surface it is called a blind spring (see
photo opposite).

Underground water, like the energy lines, can also be traumatized; geopathic
stress often involves compromised underground water known as dark streams.
In such cases it is necessary to perform earth acupuncture in order to heal the
problem. As with other forms of geopathic stress, it is important to cure or avoid
such areas as they have been implicated with many serious medical conditions.

The quality of water is of great concern in geomancy. This not only includes the
potability and cleanliness of this valuable resource, but also its energetic
integrity. There is growing evidence that water is capable of carrying spiritual
information and that unless managed consciously, it can loose its power to
nourish, regenerate, and heal. The illustrations at left demonstrate how ordinary
water can change its crystalline structure in response to verbal stimuli.

LANDSCAPE
A healing garden is a link to the divine, to the creative force of the Cosmos. A
healing garden needs to work with Nature and its forms: it should discourage
rigidity, conceptual thinking, and preconceived notions of design. It must
recognize the polarities and organic forms present in nature. Consequently, it
needs to avoid straight lines, sheer volumes and planes, and excessive use of
symmetry.

A healing garden is a micro cosmos of the larger world: each feature in the
garden has the power to represent a larger feature in the landscape:
mountains, rivers, lakes. It is through this holistic modeling that a healing

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garden can stimulate the senses, improve vitality, and promote recuperation
from physical, emotional, mental and spiritual illness.24

A successful healing garden is a co-creative process in which humans and


Nature are intimately connected through the bonds of reciprocity and
stewardship. A healing garden is a symbol of the possibilities, obstacles, and
hardships that need to be overcome in order to reach higher levels of
consciousness and a sense of our own divinity and interconnectedness with all
that is. This potential allows a successful garden to have a healing role even in
those situations where physical healing is not possible. Consequently, its users
should be a driving force in its design and should be involved in its
maintenance.

Healing is achieved through careful alignment with the forces of earth, water,
air and fire. It implies recognition of orientation in space in a cosmological
sense, and of the anthrop cosmic relationship between man and the larger
body of the planet, its creatures, and the invisible forces behind material reality.
It can also include formal religious allusions as well as iconographic additions.
Its end product is a space where many activities are possible: stillness /
movement, contemplation / interaction, wonder / discovery, mystery / creation,
relaxation / work.

Gardens should encourage healing through the interaction of patients with


healers, family and friends, the old with the young, staff and colleagues, and
even the act of being in solitude. The garden also needs to provide subspaces
and seating arrangements that allow gathering in larger groups. It needs
natural, spatially enclosed settings for talk and conversation.

Francis, Mark and Randolph T. Hester, Jr. The Meaning of Gardens. The MIT
24

Press. Cambridge, Massachusetts and London, England, 1990.

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Figure 21 : Ayurvedic farm in Valley de Bravo, Mexico, View of Landscaped Healing


space

In all cases, however, there is also the interaction of humans and nature:
plants, wildlife, and the forces of wind, water, light, and color.

A healing garden should afford opportunities to make choices: private areas


and public spaces, contemplation and people watching, various walking routes,
different kinds of seating, interaction with humans and nature, participation in
the garden’s maintenance. A healing garden should allow its users to
experience a sense of control: users must know it exists, how to gain access to
it, they should be able to use it in ways they prefer. They should enjoy a sense
of physical and psychological security. Design should encourage clarity of
layout and movement. The garden should provide a sense of enclosure and a
special entrance to convey a feeling of structure, permanence and
groundedness. It should avoid dead end paths and complex formations.

Design needs to create opportunities for movement and exercise; this brings
physical and emotional benefits and helps to combat depression. Create paths
for walking, make the garden visible from corridors that can also be used for
exercise, place rehabilitation units in view of the garden or nature, add a
walking or jogging route for staff.

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PRECEDENT STUDY – HEALING GARDEN


Good Samaritan Regional Medical Centre, Phoenix, Arizona In 1996 a healing
garden was incorporated into the medical centre in Phoenix, Arizona. The
garden is a rooftop courtyard “bounded on three sides by two-story buildings
and on the fourth side by a twelve-story tower, with porthole windows, that
looms up in one corner of the garden.” 25A water feature is the main focus
throughout this garden. The water feature symbolizes “The Cycle of Life.” The
different phases of life from birth to death are symbolized in various ways by
means of quiet pools, as well as flowing streambeds. Throughout the site water
is not only audible and visual but also touchable throughout the garden.
Seating in the garden varies from movable chairs and tables to a curvilinear
seat-wall, allowing for different levels of comfort and positions in sun and
shade. Raised beds contain plants that have low water and maintenance
requirements. Another major element featured in this garden is art. A tile artist
was brought into the project to design colourful tiled columns that actively
engage users of the site. The site is handicap accessible and also has capacity
for walkers, gurneys, and wagons. A small coffee bar is a part of the garden
that provides a social aspect for the garden users. “The garden-courtyard is
well used: by visitors and inpatients who come together to enjoy a coffee or
stroll; by visitors waiting for an outpatient who is at an appointment or
undergoing a test; by staff, for breaks, lunch, or small group meetings; by
physicians and hospital chaplains meeting with family members. A fairly large
expanse of flat concrete allows beds to be wheeled out on occasions. Another,
less direct form of use, is visual access. Outpatients attending a cardiac care
unit can exercise on the Stair.“Masters while looking out onto the garden via
floor-to-ceiling glass windows. An intriguing monitoring device secreted in the
tree canopies permits telemetry cardiac patients to continue to be monitored in

Appleton, Jay. The Experience of Landscape. John Wiley & Sons. England.
25

1999

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the garden when exercising outdoors”.26 The authors who observed this healing
garden for the most part praised the design of this space. They did express that
a couple elements about the site needed to be reworked. The extensive
amounts of concrete not only took away from the garden appeal of the space
but it also produced high amounts of glare. The suggestion for decreasing the
amount of glare is the use of earth-toned tint to be added to the concrete.
Otherwise the garden was mostly successful, providing the sound and touch of
water, native plants many of which had medicinal uses and reflected the
changing season as well as encouraged wildlife. Seating was varied according
to type, material and location in sun or shade. The garden is open twenty-four
hours a day which is great in a hot climate like Arizona where many garden
users may be more inclined to use it when it is cooler at night and early
morning hours. The addition of colourful art engages the garden visitor and the
entry and navigation in the garden are straightforward. Patient rooms include
views down onto the healing garden. One of the best things about this garden
is the fact that it is strongly supported by the hospital administration.

MATERIALS
Materiality has a direct influence on the overall sense of the environment.
Materials have the ability to affect the sound environment, circulate movement,
increase /decrease comfort, and various other actions. With this, the form in
which the material becomes a part of will also determine the powers of its
placement. The associated dimensions of the material also will play a factor in
the design. For instance, wood is a material that retains heat, is soft and
comforting, and can be associated with the concept of natural environments.
Another material like sand has a therapeutic value to it, soft to touch, and
gentle on feet. However, stone is cool and smooth to touch, but hard on feet.
When the materials become integrated in the program, the quality of the

26
Kaplan, Rachel; Kaplan, Stephen and Robert L. Ryan. With People in
Mind. Island Press. 1998

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materials will embody the vision of the space and become another dimension in
the healing environment. Other, not usually thought to be materials, like light,
sky, water, and vegetation will be manipulated with the built environment to
evoke specific responses in order to stimulate the mind and its perceptual
visioning of a space.

The following perspectives provide a vision for the “garden.” These are
intended to be spaces that integrate all the senses; vision, taste, smell, hearing,
and touch. The study is done through a phenomenological lens, designing with
a multiplicity of textures, materials, and interests to engage the mind in a playful
manner of distraction. The awareness of these physical things in the space and
their properties provides the necessary information for the occupant to draw
their own conclusions. This awareness of one’s self is the beginning to any
healing process in the mind.

PRECEDENT STUDY – THERME VALS


The prominent use of material to give user the psychological impact can be
observed from Peter Zumthor’s work. In his design of Therme Vals, the mental
impact is created by the multiplicity of textures, materials and interests to
engage the mind in awful manner. Moving forward with this inspiration, Zumthor
found beauty in the simplicity of material, which along with environment
became the major determinants of form of which the other determinants were a
function. He celebrated the idea that the material may not necessarily be
subordinate to the idea, but that it may formulate the idea in its own right. So,
with this notion the design moved forward using a grey-blue stone native to the
region called Valser Quartzite, which was layered to form a monolithic structure
nestled within the mountainside.

The work of Peter Zumthor exemplifies what sensual architecture should be.
He treats his architecture as “ a bodily mass, a membrane, a fabric, a kind of

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covering, cloth, velvet, silk”... “A body that can touch me” 27. He looks at
architecture with a poetic quality that he exhumes to his work. His work on
Therme Vals provides a clear insight of designing with the senses and how he
works sensitively with lighting and materiality. “The sense that I try to instil into
materials is beyond all rules of composition, and their tangibility, smell and
acoustic qualities are merely elements of the language that we obliged to use.
Sense emerges when I succeed in bringing out the specific meanings of certain
materials in my buildings, meanings that can only be perceived in just this way
in this one building.”28

Figure 22 : Therme Vals, Peter Zumthor. Figure 23 : Therme Vals, Peter


Materiality Zumthor. Darkness through Material

The building sits isolated as if it were a grass covered stone sunken into the
mountain, understated so that it does not take away from its impressive natural
landscape. Zumthor wanted to keep the building as natural architectonic
structure that avoids natural forms but rather as a homogenous stone mass

27
Zumthor, Peter. Thinking Architecture. Lars Müller, 1998. Print.Hamish
Hamilton, 2006.
28 Zumthor, Peter. Atmospheres Architectural environments and surrounding

objects. Baden: Birkhauser. 2006

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that depicted a sense of being hollowed out of the sunken spring water basins
and galleys “chiselled out of the dense mountain rock” The initial proposal of
the building being a cave brought forth the idea cutting through the stone mass
that filters light from the top into the engraved spaces. The ceiling consists of
cantilevered concrete slabs separated with fissures to allow light into the
spaces giving these spaces an emotive feel. All the senses are stimulated
through the experience of the space, materials and the light that eludes plays
on them. “... there was a feeling for the mystical nature of the world of stone
inside the mountain, for darkness and light, for the reflection of light upon the
water, for the diffusion of light through steam-fi lled air, for the different sounds
that water makes in stone surrounding, for warm stone and naked skin, for the
ritual of bathing. “29 .

The water, light and heat define areas in the ritual of bathing at the Therme
Vals. Tunnelled passages lead bathers from change rooms to the other side of
the bath. The spring water is poured from wall mounted copper pipes that stain
the stone beneath it. The changing rooms lead out onto long balcony spaces
that overlook the therme that ramp down to the baths. Below the baths are
therapy rooms for massage and physiotherapy. The simplicity of the
architecture, fixture and materials doesn’t take away from the eluded
environment but rather adds sensual depth to the design of all the spaces.
Zumthor invites the body into a new recollection of memory and encryption of
texture, temperature, light and sound are not only read visually but are also
comprehended by the sense of touch.

SUN
Sun exposure is one of the key environmental factors that designers can look
at in order to provoke the process of healing and to help relieve symptoms in
those who have already incurred the illness. Sun exposure is one latitude

Zumthor, Peter. Atmospheres Architectural environments and surrounding


29

objects. Baden: Birkhauser. 2006

41
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dependant environmental factor that is inversely related to MS instance and


prevalence30 according to Dr. Islam of the University of Southern California
from the department of preventative medicine.

People have begun to shelter themselves indoors, due to more indoor


activities, indoor building climates, minimizing the key environmental factor.
These shelters cut us off from our nourishment, mainly sunlight, which may be
a reason for the spike in diagnosis of illness. Our body relies on sunlight in
order to produce adequate amounts of vitamin D. Vitamin D helps with our
immune system; in fact, it has strong immune regulatory affects.

It has also been shown that periods of low Vitamin D precede occurrences of
high lesion activity whereas periods of high vitamin D precede low lesion
activity.

The knowledge that adequate light is needed to help heal weak bodies is no
new theory. Years ago, before antibiotics, the only known “cure” for
tuberculosis was to get lots of rest within an environment containing clean air
and plenty of sunshine. Thus the age of sanatoriums was born.

Munger, [K.L.], Zhang, [S.M.], O’Reilly, E., Hernan, [M.A.], Olek, [M.J.], Willet,
30

[W.C.], Ascherio, A. Vitamin D intake and incidence of multiple sclerosis.


Neurology. 2004

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PRECEDENT STUDY – PIAMO SANATORIUM


Alvar Aalto’s rise to success as a modernist architect to the level of modernist
pioneers such as Walter Gropius, Le Corbusier and Mies van der Rohe is by
his new architectural visions of his time to service the sick and isolated people,
this predominantly largely seen the design of his sanatoriums in modernist
times. He practiced his own version of modernist architecture diverging from
the doctrine of modernism

Figure 24 : Piamo Sanatorium, Alvar Aalto, View of an entrance

Aalvar Aalto believed that architecture should not just operate solely as a
functionalist machine but it should be well suited for its inhabitants and users as
he had identified , long before explorations of environmental psychology that
our surroundings the effect us. This is evident in the design of Paimio
Sanatorium in Finland. Aalto had the opportunity to site the sanatorium on the
mountainous pine slopes of Finland that boosted beautiful views all round the
site.

Nature became a driving factor for the design as the plan fans out ‘bio-
dynamically’ positioned to the compass over the site taking full advantage of its
views and natural sunlight. Sanatoriums were ideal for principles of
functionalism and modernism as they were predominantly focused on light,

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fresh air, sun and connection with nature. However, Aalto also focused his
effects on creating a building that would combine recent medical and
psychological views together with advanced construction technology at the time
to creating a building that would function like a “medical instrument”31

The Sanatorium’s shape of plan is derived from the separation of different


health variants of the patients so that similar groups are close to one another to
form a wing. The wings are linked by the central building that has common
services and functions needed in all the buildings. The building services are
intelligently hidden in central columns that can be maintained from the corridor
away from the patients. Paimio Sanatorium is unique as it pays attention to the
patients needs. The wards are stacked with ribbon windows that form a
continuous band around the building that open out to cantilevered sun
balconies that are south facing to allow optimum light into the wards. These
long balconies allow patients to come out to enjoy the healthy rays of the sun
and air in groups. The healthier patients can use the roof top solarium that has
spectacular views of the surrounding landscapes and tree tops.

Figure 25 : Piamo Sanatorium, Alvar Aalto, Patient room section, shows the
focus on light to improve wellness

31
Weston, R. Aalvar Aalto. London:Phaido, 1995

44
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Aalto states that “the ordinary room is a room for the vertical person so on must
be designed with that in mind”, thus the two-bed rooms are predominantly with
that in mind: the ceilings are painted darker than the walls to have a more
restful gaze; the room light is mounted away from the wall and the patients
head to avoid harsh light, is then reflected off the walls and ceiling where a
semi circle is painted. The slabs are canted to reflect light back into the room to
provide a sense of visual release.

Colour is very carefully thought of as colour schemes vary around the hospital
to stimulate and soothe according. Main circulation routes are bright in colour
and shared, more public spaces are painted in calmer tones. The design
approach of Paimio Sanatorium is for the patients well being and is dedicated
to catering to the needs of its patients manifested in every detail, prevalent
quality of natural light and sunlight. Its spatial qualities and therapeutic
environment was beneficial to the treatment of what was the then prominent
virus, Tuberculosis till today’s adapted function as a conventional hospital. This
Sanatorium’s healing properties must be commended for its functionalistic
approach and service to the people of Finland.

CONCLUSION
The ability of architecture to heal the mental and physical illness with the
different planning parameters and the elements that can enhance healing has
been explored. Without compromising on the need, the ability of all patients to
be outdoors in a good environment is, in my view, the absolutely greatest
strength in the design of this caring environment.

The spontaneous process of making architecture, it’s almost as if we formulate


our own “abstract” ideas of what we envisage a space to be, through special
images from memory we assemble architecture to be a part of the real world. It
not only seems that art is inherent in all of us, it is also possible that
architecture is inherent in all of us. From the development of the first human

45
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shelter, humans have always connected the craft of making to a significant act
of personal growth and of being in tune with ourselves and the world around us,
which is essentially an act of healing and therapy. As an act of healing it is
symbolic of our perseverance as a species to live a fulfilled existence. In
exploring art as healing, architecture as an art and lastly, architecture as a
healing space, I can deduce that the common bond between them is that art
does have healing qualities and it can be said that such healing qualities
provide therapeutic harmony in all of us. I believe its effects may be limitless in
measuring the benefits to the Self. The journey of healing through art seems to
be a process of retrospection, Self growth and Self discovery. This investigation
has brought about key design objectives that may be crucial in space making
concepts for my architectural intervention.

The purpose of creating a green oasis which patients can retreat to unescort by
staff, in my opinion, has to be achieved. Even in a number of problems where
the outdoor environments are concerned, everyone agrees that the existence
of the gardens and light courts is something absolutely positive and something
that is very good for the patients. It is also clear that being allowed out in the
gardens is perceived as conferring an opportunity of greater sovereignty. In this
way I think the aim of increasing normalcy has been achieved.

Patients often experience different needs from time to time, and so the architect
should consciously design the place or the environment so as to facilitate the
process which recovery.

In the design process, the architects should consciously reduce the institutional
ambience and achieve normalisation for the patients. As I see it, there is scope
for the patients to use different parts of the environment, both indoors and
outdoors depending on the stage of the recovery process they have come to.
Outdoor spaces are always with lusting green and the sound of water to heal
their agitation. Indoor is more towards the sunlight that enhance the healing
and the ventilation to give the patient high level of conformability.

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With the aid of my detail study and the precedents I have drafted four
connections that has to be consciously addressed while designing.

The connection to Self: Healing begins when one is in a space of


retrospection. The space however is one that must be comfortable and a
reflection of oneself.

The connection with the City: The city environment is harsh and busy and
tends not to offer many places or spaces of retrospection and contemplation.
The site should be a part of the city but detached from the fast pace. The end-
user should be able to arrive conveniently with public transport to the site to
allow a large catchment of people seeking a place for healing. The site should
also be in a place that is not difficult to navigate and find.

The connection to Nature: Human beings cannot live without natural


surroundings. The symbiotic relationship that exists between the two is one that
has to be nurtured. A physical and visual link with nature has positive beneficial
qualities that help in healing and health in general.

The connection with Light: Natural sunlight kills harmful bacteria and cleans
air. Apart from these obvious natural benefits of sunlight, natural light - when
controlled - gives a space character that is sensual so giving a space an
emotive quality which can be felt by the end-user. Light is also a symbol of
growth and life as it benefits the natural world in that way.

This study on ‘Healing spaces in architecture’ is an endeavour of understanding


the conceptual way to achieve healing. Since it is vast field of study with the
number of ongoing researches, this has profuse scope for further investigation.

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IMAGE REFERENCE
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images&cd=&cad=rja&uact=8&ved=0CAQQjBw&url=https%3A%2F%2Fwww.s
amueliinstitute.org%2FImage%2520Library%2FOur%2520Research%2FOHE
%2FOHEexternal_high.jpg&ei=8sgiVd38AtXluQSUv4GAAw&bvm=bv.8994745
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Figure 17 : Van Eyck, A. Aldo Van Eyck works compilation by Vincent Ligtelijn.
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M:

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