1.
Introduction
“…Buildings, spaces between them…make different lives, influence how we think, feel, behave-how we are’ (Christopher, 2002).
Many specialists of various fields, including sociologists, therapists and architects have repeatedly argued about how place and the design of its spaces communicate with the human psyche, affect the way in which people react to their lives and how they develop. And this might be said to be rather crucial for any individual who requires long term constant care or needs to recover from a period of physical, social and emotional instability such as the multi-faceted break down and loss of self during any treatment or healing process. It is important to note from the outset that architecture is not a treatment, but can most significantly become part of the healing process through the creation of spaces that foster and provide meaning to those activities utilized to achieve gradual rehabilitation through a therapeutic environment. Light, colour and movement within a residence as well as landscape and location are essential elements of this architectural therapy and the paper will seek to bring their relevance to the fore.
“..form and space can be insidious shapers of person and community or they can nourish and spur development, both social and individual” (Christopher, 2002).
It is a setting which readies for social inclusion and does not bunch up people as a group of patients who simply need to take their medication or stay indoors for a prolonged period of time but as active recipients of change and individuality. Not merely a number behind a ‘health facility’ door. Architectural design can provide the corner stone of this individuality, with spaces built as an interactive process as opposed to ‘holding a disorder within’. As Cynthia Leibrock puts it, even the little things in the design of a building can play their part in the psychology of the healing equation; such as the way windows reflect the sunlight in a therapeutic community residence.
“…The power of a healing environment comes from the design details that empower patients to take responsibility for their own health” (Leibrock, 2000).
Before delving into how building design can interconnect with the healing process and activities in providing healing for individuals with long term problems, one must provide a detailed outlook of the approach that can serve this type of architecture. And this is the
concept; or rather the healing principle of the therapeutic community, a relatively recent way of creating the sort of environment that allows the ill and diseased reformation through the development of a team spirit in conjunction with ways of restoring their misplaced individuality.
2.
Therapeutic Community
2.1 The process of the Therapeutic Community
One of the most widely accepted definition of the therapeutic community is the 1993 Ottenberg thesis of an environment in which ‘people live together in an organized and structured way in order to promote change and make possible a free life in the outside society…the community forms a miniature society in which residents fulfil distinctive roles…designed to promote a transitional process…’
It must only be a foundation or facility in name. In essence, the therapeutic community should become ‘society away from society’, a shadow of reality for those with the determination or even so, the decisive push by family and relatives to rediscover and re-coordinate that inner creativity self, the social and individual personality lost through illness. As argued, this type of healing process, its residential philosophy aside (and this is where architectural design comes in), does not usually apply to a fixed setting, “but rather to the principles of the care
that is offered…a communal approach which is also democratic, collaborative and encourages participation…” ( O’Hara, 2010).
Thomas Main was the British psychoanalyst who coined this term in the 1950s, as the response of psychoanalysis to the failure of psychiatry, incarceration programmes which viewed addicts as mere criminals and stigmatized them as outcasts or even mentally disturbed through abuse, as well as purely medication approaches. Strangely enough though the therapeutic community model developed by Maine and other analysts was based on a World War II experience in Britain, as army psychiatrists, who had to deal with hundreds of traumatized soldiers returning from the front, considered, in their desperation from the failure of the conventional medication or one to one therapy approach, to apply a group method that would allow those who had suffered severe distress to overcome their psychological fears and return to the front as physically and emotionally healthy as possible.
Instead of medication treatment therefore, they provided the necessary tools to the community of patients in dealing with their own problems, making them part of the process with which they could overcome their traumatic experiences. As Crampling notes, this later became known as the ‘living-learning’ method. Maine took this and applied a psychoanalytic
approach to it. Some later appropriately dubbed it ‘social psychiatry’. It formed the beginnings of an attempt to consider rehabilitation as a psychological awakening through a group environment, in which members (not patients) and experienced professionals interact in a setting promoting trust and individuals are encouraged to become part of a community with the goal of rebuilding their social skills, such as responsibility and integration. This community philosophy essentially places the healing process into the hands of addicts themselves in a controlled and voluntary but not institutionalized environment, finding methods that allow them to rebuild their ability of dealing independently with their own problems.
Many of those seeking or being encouraged by their environment to follow the therapeutic community approach have gone through an extended period of social and behavioural dysfunction, the substance problems gradually eroding-in spite of what educational or professional capabilities they might have had-every sense of societal responsibility, creating a situation whereby they need to essentially re-invent themselves, develop integration skills and individual creativity. This is why this form of residential therapeutic community involves“…an internal hierarchy of jobs and
progressive responsibilities, and a variety of medical, educational, and vocational services” (O’Hara, 2010).
Architecture fits into this process, as the outer shell providing the necessary support to the inner self-corrective therapy. There are of course no guarantees of success in such cases. However, at least the connection of interior design and community spirit as a means of moulding a socially functioning individual forms an alternative that puts the individual first, as opposed to the medication institution like processes that have not managed to make any headway, both in attracting the trust of addicts who make the step to rehabilitation, as well as eradicating existing prejudices and public opinion views. The therapeutic community, as referred to earlier in the paper is not about being locked in, but a home in which the individual with the need for care, becomes part of the method of their gradual return to physical and emotional health, they become involved in the decision-making process, improving their creativity through the group. The basic premise is to become the change within themselves, to sense that even though they live in a treatment community, the environment surrounding them is one in which they feel not part of the problem, but part of the solution on their way to re-learning the social process.
“Individual client members are involved in all decisions about their own care and treatment”.
(O’Hara, 2010).
As heard in the 10th European Conference on Rehabilitation and Drug Policy, rehabilitation is not about shutting the door of the world in the face of the addicts, but giving them the ability, through sharing their life experiences to reach a glass door on their own, where they can see social inclusion laying in the horizon.
“…for the suffering soul, world is healing” (O’Hara, 2010).
2.2 The Fundamental Components and Basic Structure of Therapeutic Communities Therapeutic communities, drug-free residential settings are primarily of a humanistic philosophy in which the member gradually develops social group responsibility and a sense of personal growth through structured activities but also the opportunity of more creative expression such as theatre therapy, art, photography and prose writing that bring out untold emotions and help the resident through this active self- help process, become aware of their problems and finally come to terms with what brought them to that situation. The member is forced to become part of their future, by developing on a daily basis individually and with the group, having a daily routine, starting at seven in the morning, sharing and having a common target, feeling responsible also through the choice of employment that can be provided at the facility. For example many communities make their own furniture. Work is a means of strengthening the sense of community and developing the communication and interpersonal tools needed.
“…the therapeutic community movement holds a multidisciplinary view of health which is based on ideas of collective responsibility, citizenship and empowerment” (O’Hara, 2010).
The therapeutic community is usually at a distance from city centres where drugs are much more accessible, (but not too far from the reminder of daily life-the sports facilities of the Groot Klimmendaal rehabilitation centre in the Netherlands are also used by the general public as a means for residents to feel social proximity) and close to the positive influence of nature. Funding also determines the location of therapeutic communities. The ultimate aim is for these residences to become a microcosm of real life, a placebo of a social situation, whereby conditions proceed pretty similarly to a societal motif-providing solution to situations that might come up through activities or assigned work, planning a schedule, following necessary rules, having control over your life as well as realizing that the way one
conducts themselves must be respectful to the group. Individual and group therapy sessions are conducted daily, lasting more than an hour and offering the opportunity of openly expressing emotions.
“Problems and their solutions are discussed in the community before action is taken. The discussion is regarded as a learning opportunity” (O’Hara, 2010).
Based on the sociological approach of community as method, residents gradually learn, through a hierarchical system, open communication and expressing themselves in the group and through activities, to discard negative emotions and are “taught to use the peer
community to learn about themselves, to change lifestyle and identity”. As Alcorn puts it,
gradually building or re-building a new life, for which they are fully responsible, always having in mind that professional monitoring is daily and reviewing of the community’s progress is conducted at a regular basis to establish whether the residence is achieving its goals of gradually creating new identities that are well on the road to physical and mental rehabilitation and are, through work and activities inside the community, building new positive strategies of dealing with their problems. Strategies that they will be able to put into practice once they are able to face real social situations. Therapeutic communities
“…provide a combination of therapeutic involvements between residents and staff and living in a caring and challenging community as the principal mediums to encourage change and personal development” (Cindy, 1997).
3.
Therapeutic Architecture
3.1 The Role of Architecture in Therapy
If drug addiction rehabilitation is mostly about bringing positive feelings to the fore and helping to build a new identity for members of therapeutic communities, then architectural design, is perhaps the most decisive of factors in how space is utilized, both in practical terms and landscape wise, to uplift the spirit and provide the necessary environment in which community daily life and activities can become most effective. Christopher Day believes that buildings have the life the architect gives them, a personality that is either positive or negative, and that aura is captured by those who reside in them.
“…The more ‘felt’ are buildings, the more connected to rhythms of day…they value the individuals they will house…environment can heal as well as harm…places of spirit…nourish both individual and societ” (Christopher, 2002).
“Place is not simply a set of coordinates, but is constructed through finding meaning in the social and built forms we inhabit” (Christopher, 2002).
In other words, the building, a city and the way it is designed does not just form slabs of concrete, but is literally a social construction, that can have an influence on those who reside in it. As outlined earlier, this is truer of people, in this case, addicts who are in a process of rehabilitation, a tough community healing programme that seeks to root out their negativity. In such an instance, the energy and individuality their residence might project could be crucial in how they respond to this process. Colour, they way they are able to move within the building, staircases, connections between rooms, surrounding nature can all play a role, as will be analyzed, not just in underpinning the mood of the residents, but also whether they feel welcome in the building, whether it forms a connection to their emotions and physical presence and by extension if it provides a motivation for them to follow the programme. A rehabilitation centre in the Netherlands has left nothing to chance, paying particular attention to natural but also artificial lighting as both aspects of mood and energy.
“…Natural daylight deep in the heart of the 30 metres wide building was allowed. The interior was enlivened by interplay of striking but subtle colours and direct and indirect artificial lighting”.
The same connections are made about colour, with Day pointing out that preference in this case is highly personal. For the individual in a therapeutic community the slightest detail in a room, be it his personal space or a place of group therapy and activities might affect the way the individual receives the treatment, bringing about as negative physical or psychological reaction.
“…How different is the living grey of an overcast sky or a blue wash over brown to the dead grey of a concrete wall.” (Christopher, 2002).
Clearly, a building balance or imbalance, whether be it colour, the light in a building, design or even the length of a corridor can affect the way in which residents in a therapeutic community react to the energy of the space and can relax and release themselves. The example of a group therapy session in Reading, England, provides quite an amazing example of how architectural space can play with the psychology of the individual, particularly so when this is a member of a therapeutic community, seeking positivity.
“…The dependency culture of being in an old asylum was symbolized every lunch time when the food was delivered and plugged in by a porter” (Crampling).
In essence, the daily life within community housing individuals who need to feel as close to a home as possible must be designed having buildings in mind that are both practical but also do away with any institutionalized emotions. According to Leibrock researchers in the field of anthroposophic medicine have maintained that colour can be a major contributing factor towards patients regaining health. She describes green as a colour which is psychologically perceived as providing safe refuge, while coral, peach and yellow are seen as warmer choices for a dining room and blue is considered relaxing. In her book ‘Design details for health’, in which she associates good health with the positive aura of space, she argues that warm colour hues are often associated with extroverted responses and social contact.
“…A monochromatic colour scheme throughout the building may be perceived as institutional…It can contribute to sensory deprivation which leads to disorganization of brain function…” (Smith, Watkins, 2010).
3.2 Kinaesthetic and Landscaping
“…Kinaesthesia is the exploration of our environment through movement; this can be movement with the eyes or with our body…” (Schaap)
The sense of movement in a space, deriving from the combination of the Greek words ‘kinisi’ and ‘aisthisi’ has been said to affect the way the individual reacts to the building, how it marks their behaviour, mood, how it creates and maintains a positive or negative attitude to the particular situation they are facing. Architecture can become a strong determinant in the successful kinaesthetic of individuals, particularly in the case of people with psychological imbalances such as drug addicts, who have joined therapeutic communities seeking to regain the peace of their inner self in order to build or regain their social identity. So the way they are able to physically interact with their surroundings, the kinaesthetic of human bodies, can be said to be decisive in how they adapt to their daily routine in a group community.
“Laban refers to movements directed towards other objects and bodies. The latter, termed spatial-movements, construct nearly imperceptible forms of social interaction…” (Zaida)
Ziada, utilizing the model of the ritual space of Muslim mosques and Soviet assemblies, argues that building spaces for collective activities, (much like therapeutic communities), can, through their design, produce a positive sense of kinaesthetic in individuals, who are in situation of ‘conjoined attention and communal practice’. For people in drug reformation this can be said to be highly relevant, as they need to adapt to their new tasks and responsibilities and learn new skills that can change their mobility in a positive manner. So in other words, improving one’s kinaesthetic skills in a setting that encourages techniques and therapies to do so is a highly significant step towards an improved physical presence that also brings about internal changes. In simple terms, building positivity produces body positivity, as well as techniques to further improve this positivity. Besides, movement is a major part of sensory perception. According to Dutch architect Jasper Schaap, who co-wrote the paper ‘Design your own Mind’ in 2009, contemporary architecture must turn the tide of its alienation, through buildings that are not monochromic and mono-visual, spaces that participate and affect human movement and action, designs which encourage multi-sensory perception, bringing to the fore the power of the senses, beyond the visual and the spatial. As the ‘Design your own Mind’ researchers point out, buildings which encourage a highly positive sense of kinaesthesia, connect with the individuals that reside in them. The Schaap thesis is that moving through space with the body, automatically makes the architecture experience less static. What Pallasmaa calls ‘the eyes of the skin’ If you manage to wake up these eyes, the building immediately becomes a source of positive energy of particular importance to drug addicts who need to develop a new self.
“…If we succeed in enticing the senses, people can participate again in their surroundings and regain their identity in the contemporary world…” (Schaap).
A 2000 paper on a Rehabilitation and Education village for Drug Addicts uses the same premise in designing an art therapy room. The senses are prodded through a wide space that allows rich daylight, distance between individuals so each one can feel the space of their own creativity, as well as an informal furniture setting, that further encourages a spontaneous reaction, limiting the emotion, the perception of you will, that this is an exercise or an obligatory activity. But landscape can also contribute to a heightened positive kinaesthesia in therapeutic communities, with Ling providing the case study of The Good Samaritan Regional Medical Centre in Arizona, whereby the space triggers the senses through an award winning health design. The surrounding garden awakens
“…patients’ senses of sight, smell and touch, prompting body movement by inspiring the patient to explore the garden” (Jean- Mary,2009).
Water flowing through the garden as well as proximity of plants to all patients, allows, as pointed out in the Ling paper, the interactive sense of touch.
But the same effect, it is underlined, can be achieved through keeping an open space landscape simple, without elaborate additions, such as the case study provided of the Harrison hospital in Washington, where the architect focused on creating a stony pattern with the least of plants, creating curvy pathways, a process known as abstraction, that awakens the individual to the realization of their problems and smoothly allows them to concentrate on the therapy.
Leibrock introduces the concept of the Healing Garden, whereby nature, through landscaping, becomes part of the therapeutic process. Many addict communities might not have the means to create such conditions, but as the paper will argue through two case studies, when it is possible through design it can provide a much needed psychological boost. Leibrock cites studies linking sunlight exposure to wellbeing and details the architectural innovation of American James Burnett, outlining his plan of a bed-accessible garden so that contact with nature can be re-established.
3.3 Light and shadow
Architecture is the masterly, correct and magnificent play of volumes brought together in light ...the history of architecture is the history of the struggle for light.” (Le Corbusier).
Light and particularly the life-giving rays of the sun, have been well documented as a major determinant of vitality and well being, more so in therapeutic environments where such positive natural stimulants can go a long way towards developing the desired attitude to individual change. In therapeutic architecture therefore, the way sunlight is utilized is one of the factors in creating a healthy environment and psychological motivation. The way the corridors are lit, the way the windows are placed throughout the building to reflect warmth and how light and shadow appears in the space, can affect the balance or imbalance of rooms, always in conjunction with colour, shape, interior design and landscape features. Once again it’s all about the way the senses perceive the surrounding environment, the degree that space resonates with the individual self. Marilyne Andersen of MIT is amongst a group of young architects and researchers who have become increasingly aware of the importance of incorporating sunlight in building design. They have realized that…
“…Light is not only an amount of energy," Andersen said. Â "It also provides us with the
means to reveal spaces and volumes and interact with our environment." (Smith, Watkins,
2010).
For Day, sunlight is a great part of the spirit of place and directly associated with physical and psychological health. It’s all about energy and mood and how it positively connects people with their environment, particularly so when it comes to a long and arduous process of self-healing, such as in addict therapeutic communities. Daylight is also closely associated with kinaesthesia and as Day argues, natural light through what he calls interactive directions, constantly changes the colours and shadow dynamic, stimulating the eye, which is essentially for health,
‘…as NASA sensory-deprivation research has demonstrated’ (Christopher, 2002).
Leibrock offers a host of ideas on how public areas in treatment centres can become more
sensory-positive, for example waiting areas, as she points out, where patients and their families will feel more comfortable when provided access to nature and natural light. This can be achieved with the waiting area (or for example group therapy areas in the case of therapeutic communities), being designed in an atrium or adjacent to a courtyard. What is
clear to Leibrock is that natural light deinstitutionalizes and humanizes the space, making residents feel they are not enclosed, but receiving therapy in a home-like environment. More so in terms of therapy
“…sufficient lighting is particularly important in areas where concentration is required, decisions are made or danger is present.” (Christopher, 2002).
4.
Therapeutic Environment
4.1 Introduction
Healthcare facilities are designed not only to support and facilitate state-of-the-art medicine and technology, patient safety, and quality patient care, but to also embrace the patient, family, and caregivers in a psycho-socially supportive therapeutic environment. The characteristics of the physical environment in which a patient receives care affects patient outcomes, patient satisfaction, patient safety, staff efficiency, staff satisfaction, and organizational outcomes. The effects can be positive or negative. No environment is neutral. A healthcare environment is therapeutic when it does all of the following:
Supports clinical excellence in the treatment of the physical body
Supports the psycho-social and spiritual needs of the patient, family, and staff
Produces measurable positive effects on patients' clinical outcomes and staff effectiveness
4.2. Theory / Background
Therapeutic Environment theory stems from the fields of environmental psychology (the psycho-social effects of environment), psychoneuroimmunology (the effects of environment on the immune system), and neuroscience (how the brain perceives architecture). Patients in a healthcare facility are often fearful and uncertain about their health, their safety, and their isolation from normal social relationships. The large, complex environment of a typical hospital further contributes to the stressful situation. Stress can cause a person's immune system to be suppressed, and can dampen a person's emotional and spiritual resources, impeding recovery and healing.
Healthcare architects, interior designers, and researchers have identified four key factors which, if applied in the design of a healthcare environment, can measurably improve patient outcomes:
Reduce or eliminate environmental stressors Provide positive distractions
Give a sense of control
The application of these factors has been focused on the patient and patient's family. However, there are also recognized potential benefits for staff and caregivers in terms of satisfaction, effectiveness, and staff retention, from environmental factors such as:
Noise reduction
Same-handed patient rooms
Access to daylight
Appropriate lighting
Providing 'off-stage' areas for respite
Proximity to other staff
Appropriate use of technology
Decentralized observation, supplies, and charting
The benefits staff receives from these environmental factors may impact the quality of care patient experience.
In general, Therapeutic Environments have been proven to be cost-effective by improving patient outcomes, reducing length of stay, and by enhancing staff satisfaction, recruitment, and retention of staff.
4.3 Practice
To create a therapeutic environment, all members of the design team—medical planner, architect, engineer, interior designer, site and landscape designer,—are responsible for using the power of design to find solutions that will affect the patients and staff in positive ways, throughout the facility; from the parking lot, approach, and entry, to the public spaces, clinical spaces, and ultimately the patient room. Following are some specific design criteria that are used or are being studied:
4.3.1 Reduce or Eliminate Environmental Stressors
For example:
Adequate space should be provided in public areas and waiting rooms to avoid crowding
Perceived waiting time can be mitigated by positive distractions
Visual and noise privacy
Odors that are objectionable or 'medical' can create stress
Wayfinding; the built environment should provide clear visual cues to orient patients and families, and guide them to their destination and return. Landscaping, building elements, daylight, color, texture, and pattern should all give cues, as well as artwork and signage
Reduce or eliminate sources of noise; other patients, public address systems, equipment 'clatter', loud conversations at nurse stations
Acoustical treatment of corridors adjacent to patient rooms; carpet tiles, rubber flooring
Acoustical separation of staff work areas from patient rooms; "even low noise levels (40-58 dB) combined with poor acoustics can reduce sleep quality and negatively affect other outcomes" (Roger Ulrich, Ph.D., Healing Environments Virtual Seminar, AIA, 2003)
Appropriate lighting systems; "lighting can be a stressor that alters mood, increases stress, disrupts daily rhythms, and modulates hormone production" (J. Roberts)
Provide lighting that supports natural circadian rhythm; "Provide natural daylighting where possible, or bright white lights (400-600nm) in the daytime. Ensure absolute darkness in the evening; for nighttime movement only red lights (650-700nm) should be present in the rooms." (J. Roberts)
Maintain good indoor air quality; 100% outside air where climatic conditions allow
Color, while subjective, can be a design factor in reducing environmental stress when understood and used in the context of the color preferences of a project-specific population.
4.3.2 Provide Positive Distraction
For example:
Views of nature, from patient rooms, and wherever possible in lobby, waiting, and other 'high stress' areas
Chapel, meditation room, and meditation gardens
Artwork depicting nature, including back-lighted photographs of nature
Music; live piano in public area, recorded music in patient room when programmed specifically to create a healing environment
Mild physical exercise; corridors, public spaces, and gardens that invite walking when appropriate
Pets and other activities or elements that allow for a sense of stimulation that help nurture a patient's sense of positive well-being
4.3.3 Enable Social Support
For example:
Family zone in patient room; with furniture for sleeping, phone and internet connection, reading light with separate control, and out of the way of staff
Provide places where patients can engage socially with family and other caregivers, such as the Planetree feature of a Family kitchen on inpatient units where family members can prepare food for patients and families to eat together
Provide accommodation for accompanying family member to be with patient throughout the examination and treatment process
Organize Family Focus Groups and Patient and Family Advisory Councils to be an active part of the design process, tuning in to the specific needs of the population and community to be served, as recommended by the Institute for Family-Centered Care
Ensure culturally appropriate environments
Consider sociopetal versus sociofugal spaces: Sociopetal spaces facilitate social behaviors and the development of social groups (nonfixed seating, round tables, etc). 4.3.4 Give a Sense of Control
The ability of the patient to control the environment directly contributes to successful patient outcomes. A sense of control extends from privacy and lighting to choosing artwork being hung in the patient's bedroom during the hospitalization, to ordering meals from room service. For example:
Private patient rooms result in better outcomes, according to recent studies commissioned by the Facilities Guidelines Institute and conducted for CHER
Give the patient as much privacy and control over it, as is consistent with the need for nursing supervision
Give the patient control over the immediate environment; i.e., radio, TV, reading light, night light
Wayfinding; the built environment should provide clear visual cues to orient patients and families, and guide them to their destination and return. Landscaping, building elements, daylight, color, texture, and pattern should all give cues, as well as artwork and signage
Provide mini-medical library and computer terminals so patients can research their conditions and treatments—as in the Planetree model
Choice of lighting; patients and staff can benefit from personal dimming controls
Choice of artwork
Volume and programming control of televisions in waiting areas
Room service/menu selection
Storage area for patient belongings 4.3.5 Tools
Every healthcare project should begin with a review of existing available literature on design interventions that have been proven to improve patient outcomes, staff effectiveness and patient safety, and a decision made with the users as to how each one might apply to the project, and what outcomes / benefits would be expected. Checklists can assist designers and users in evaluating existing conditions and in setting goals for new facilities planning and design. Design goals that are set and clearly defined at the beginning of a project can serve as research questions to be answered by Post-Occupancy Surveys, data collection, and evaluation.
4.3.6 Operational Models
Aligning the healthcare organization's operational model with the design goals early in the process is a key to success in creating a collaborative, emotionally, spiritually, and socially supportive environment.
5.
Case Study
5.1 Groot Klimmendaal Rehabilitation Revalidation Centre-Arnhem Netherlands
This is the magnificence of ‘therapeutic’ glass where the sunlight is ever-present, bringing residents as close to nature as they might ever hope to be. The overarching characteristic of this two-storey glass rehabilitation centre is direct contact with nature, a landscaping decision that places this building in an idyllic forest environment, but not at a great distance from the city of Arnhem, as the sports facilities of the centre are also used by the community, as a means of encouraging addicts to feel a sense of belonging.
“Despite its size, the brown-golden anodized aluminium facade allows the nearly 14.000sqm building to blend in with its natural surroundings” (Koen Van Velsen, 2011).
Figure 5.1: The exterior facade of the Groot Klimmendaal Rehabilitation Revalidation Centre Source: Website
Improving positive kinaesthesis is clearly the concept guiding the continuity between exterior and interior, through an innovative height glazing along the central area of the community that connects the internal aspects of the building in a subtle but importantly practical design, which ensures that residents don’t feel enclosed, cut off. The brightly lit façade of the restaurant establishes warm emotions during day meals, with the hall windows virtually touching the surrounding forest in a welcoming environment.
“…A strong visual and tangible presence everywhere because of the surrounding nature. The user was allowed to revalidate whilst walking.” (Koen Van Velsen, 2011).
Fig 5.2: Restaurant inside the centre Fig 5.3: Connection between the interior and exterior
Source: Website Source: Website
All recreation, fitness and other common use spaces such as the gym, swimming pool, restaurant and theatre are located in close proximity at entrance level. The facilities are also used by residents’ families’ as well as members of the local community. The philosophy behind facilities being used by locals is that the patient, who is placed at the centre of the community gradually, begins to feel re-integrated. The concept behind the design is first and foremost, care and therapy not through detachment and negative seclusion, but designing the building and its spaces to become part of the surroundings and the community. A centre designed to encourage the self-awareness of the residents about their problems and enhance their degree of responsibility in overcoming their problems through their own personal involvement, but also interaction with the group. The open environment of the interior design is set to promote self-confidence, with great emphasis also placed on recreational activities and therapy through arts expression. Architect Koen van Velsen made sure no part of the building is detached by creating a direct route between the different floors, as well as alternative routes to reach different areas. This brings about both a positive sense of physical movement, as well as a community spirit. The interplay between light and shadows is also evident, in combination to other psychologically boosting effects, such as colour and shapes.
“…Natural daylight deep in the heart of the 30 meters wide building was allowed. The interior was enlivened by striking but subtle colours and direct and indirect artificial lighting.” (Koen Van Velsen, 2011).
Fig 5.4: View of the interiors Fig 5.5: Visual connection
Source: Website Source: Website
In practical terms, the design of mechanical and electrical installations was energy saving, particularly through thermal storage. Designed to be easily maintained for a long period of time, the rehabilitation revalidation centre forms a sustainable multiuse, closely-knit building exuding stimulating therapeutic components. A building arranged not just for use exclusively by residents but also the community, forging a feeling of social belonging for everyone. Complex in its web of connected floors, rooms and public spaces, but also simple in its desire to unite and encourage residents to use and benefit from the whole area, making it practical and accessible, it establishes continuity and a diversity of use, utilizing nature, light, colour and kinaesthetic. This was the winner of the 2011 Architecture Festival in the field of health.
“…The design ambition was not to create a centre with the appearance of a health building but a building as a part of its surroundings and the community” (Koen Van Velsen, 2011).
Figure 5.6:The exterior
5.2 Muktangan Rehabilitation Centre, Pune
The Muktangan de-addiction centre is run by Muktangan Mitra, a Pune based NGO. The institute is located in Pune and is designed by architect Sirish Beri taking into account the natural topography and terrain of the immediate surroundings. It is a small institute consuming 3700sq.m of built-up area. Muktangan has been involved in the herculean task of creating a drug free society for the past 12 years, Muktangan has treated over 14,000 patients and has been involved with the creation of awareness amongst the public of the problems faced by a drug addict.
Sirish Beri’s concern for this project included whether architecture could provide the required therapeutic spaces by bringing man closer to nature to its beauty and harmony and whether the quality of outer space can affect our inner psychological space. To create this natural therapeutic ambience, natural stone, plants, creepers, the sky and the clouds were made a part of architectural vocabulary. Features such as raised planters with spread of flowers at the window sill, help cheering up the patients while entering the consulting room.
Figure 5.7: Cultural activity in the centre Source: Website
A sense of freedom is also very important while dealing with the drug addicts as closed environment may not foster the therapeutic environment. To create this sensation Beri has used a system of courtyards which cut right through the centre of the entire volume providing the sense of transparency in the mass. This in turn also helps break all visual and physical barriers and promote healthy interaction. Beri however did not take into account that
continuous visual interaction with outside visitors may not always be helpful to the patients, or safe. By providing a continuous open street along the entire volume the potential for escape exists. A sense of privacy is thus not very strong due to this over provision of freedom.
The use of natural stone was to ensure a sense of belonging. The patients would know their natural surroundings and the buildings gels well with the immediate surroundings. However the continuous rock façade all around the building gives it a fortress like connotation, which in turn speaks of not only a highly secure zone but also a very isolated environment. It contradicts the welcoming attitude which Beri might have wanted to create when he added an exhibition hall as a dominant function. Both the ideas of creating public awareness by bringing people into the institute, and creating the sense of security and privacy and treatment like environs, are apt for a drug de-addiction centre. But Beri’s enforcement of these ideas within the same space has resulted in a contradictory structure.
5.2.1 Visual clarity
The site is designed on contours with proper utilization of levels.
The massing of structure allows the expression of freedom and helps the patients to feel more secure.
Fig 5.8: View from amphitheatre to entrance Fig 5.9: Raised planters at window sill
Source: Author Source: Author
A balance is struck between a sense of freedom and disciplinary control of the centre, Diffused light entry creates a peaceful and serene atmosphere within the hall.
Raised planters with the spread of flowers at the windowsill are used to cheer the patients as soon as they enter the consultation room.
5.2.2 Natural elements
The natural stone, plants, creepers, the sky and clouds becomes the architectural vocabulary to create a natural therapeutic ambience.
Fig 5.10: View of amphitheatre from the building Source: Author
5.2.3 Facilities
With the provision of libraries, exhibition hall and a gym along with the kitchen courts and large play areas, Beri has managed to create the required interaction spaces, yet there is lack of diversity in the workshops available to the patients, which tends to create a sense of monotony for the users.
An exhibition hall or an amphitheatre promotes a healthy interaction but a common waiting area does not.
There are different therapies for the patients like music therapy, art therapy etc which tries bringing their actual potential bringing them confidence in living.
There is a dining room which has attached kitchen to it where in these patients are assigned to certain tasks related to cooking.
An important inference of this case study is massing of the built. Beri has created a transparency in the mass and has in turn allowed for the movement of the patients through outdoor spaces, which is therapeutic in nature. He has also provided certain degree of sense of
security through the use of wall stones and exterior façade. Thus Beri has incorporated three things on this rehabilitation centre, sense of security. Sense of openness, ambience of hope and trust.
Our friends graduate to subsequent weeks and evolve in a wonderful group. Just like defence staff and college students. The five week program is designed keeping in view the emotional cognitive and awareness levels of our friends.”-Dr.Sanjay Bagath
5.2.4 Zoning
The building is planned as an inward looking structure applying the concept of drug rehabilitation therapy itself i.e. to create an environment for the patients away from the outside world.
The building has an introvert concept with all rooms opening to the central court. All rooms opening to the central court provides a central interaction space for the
patients at all times making the place look lively.
No separate space has been provided for recreation which plays a major role in the recovery of the patients.
Fig 5.11: Ground floor plan Source: Website
5.2.5 Landscaping
Space has been specially created just outside the windows, having lush green planters to provide patients with pleasant view outside.
The amphitheatre is also largely landscaped with long creepers and pavers intercepted with grass.
The small central courtyard forms the core of the radial planning of the building. On the façade for ornamentation as well as climatologically creepers have been
provided.
Open spaces being one of the most important elements are not available. 5.2.6 Built form and architectural expression
By using subtle colours scheme and natural and smooth structural elements the interiors of the building provide a warm soothing environment contrary to the outer façade.
This makes the place more seem like a naturopathy centre compared to a prison environment.
Fig 5.12: Entrance Source: Author
5.2.7 Lighting and ventilation
Ample natural lighting is provided throughout the building due to large window openings and through the open courtyards and the amphitheatre.
Lighting according to various psychologists at Muktangan, is the vital part of the treatment process ad a dark corner or space reminds the patient of his depression and past where as bright light takes the patient away from such situations.
Fig 5.13: View of central lobby Source: Author
The idea of this project was to design a building that would have a therapeutic value contribution to the healing process of the drug addict. A balance was struck between the sense of freedom and disciplinary control. The design unifying transparency becomes expressive of this freedom and increases the physical and visual interaction, there by reducing the isolated alienated feeling. Even the main entrance is transparent. The transparency, the cut-out, the terraced balconies and the seating, encourage the patients to open up. The small enclosed landscaped amphitheatre breathes light and joy in the building; it binds the various functions together, creating a much-needed ‘sense of belonging’.
6.
Conclusion
The recent declination of architects from conventional principles of design in the field of health care has been spectacular. Professionals have realized that multi-dimensional practicality but wrapped in simple details is the way forward, with light, colour, kinaesthetics, connection of spaces and nature at close proximity (wherever possible) forming the ingredients. Therapeutic architecture has taken a strong anthropocentric turn.
When it comes to drug addiction rehabilitation centres, the focus is now firmly towards constructing buildings that is de-institutionalized. Where addicts gradually gain the feeling of awareness, self-confidence and don’t feel they are closed in by a rejecting finger pointing society, but merely passing through the therapeutic community on their way to recovery, re-integration into the group and re-invention of the self. Through group counselling, community work, responsibility, recreational therapy, group exposure, interaction. But in buildings that nudge the senses into self-healing, not push them back oblivion. It has to be architecture that brings about a continuous process of change, even if the start is just a window reflecting sunlight in the right place. It will act as a research and information centre on substance abuse in the state.
The needs of the individual sufferer-and don’t use complex constructs-but the materials nature and simplicity of space can provide as the ingredients of a healing design. Truth, beauty, good. That was Plato’s philosophy.
To make the drug addicts feel comfortable which enhances the pace of recovery by providing the best environment that helps in psychological treatments. The seminar helps to arrive at an architectural proposal for rehabilitation centre that that helps the addicts to integrate themselves to return to sobriety and become a productive member of the society. This aim can be achieved my fulfilling the following objectives.
The rehabilitation centre designed keeping in view the welfare of all affected population in the context of drug addiction. It should be an eco friendly structure which blends into the surroundings. It should give a feeling of vast space and freedom without compromising security.
Natural elements must be greatly included in design as it is part of certain treatments like psychological, managements.
The concept behind the proposed drug rehabilitation centre at Kolkata intends to emphasize on the therapeutic environment. The following will be addressed while creating therapeutic environment:
Reduce environmental Stress by using familiar material, cheerful with varied colours, natural lighting, outdoor- views and access, mediation rooms/ gardens. Music and art, easy way finding process, attention to proportions, scale, colour, detail, bright open public spaces, noise reduction, no medical odours, good indoor air quality, play on light and shadow.
Provide Positive Distractions by making surrounding cheerful, bright colours, group therapy halls with areas to respite.
Enable social support outdoor views, access, activities, large open social gathering spaces, privacy, and accommodation for family members.
The centre will also give a sense of control to the patient by giving them colour corrected light where natural light is not possible, controlled views but access to outdoors, changes to be allowed in rooms, easy way finding, the design will be on human scale, will be homelike with intimate environments, areas of respite, privacy, medical library.