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Transcript of Environmental Response
both physically and mentally
(and what designers can do about it)
Jan A Golembiewski PhD
Antonovsky's (1987) Salutogenic theory is far less abstract.
The stimulation we call stress is information: and our ability to cope with a flood of information, be it good or bad is what ultimately determines out generalised state of health.
Health improves when a Sense of Coherence is fostered
This is in turn supported by the things that help us cope.
The brain is an organ that perceives,
manages and creates
Architecture mediates almost all experience and moderates a great deal of behaviour. By and large, the choices provided by architecture is qualitatively even.
A left turn is the opposite of a right - but the experience is nearly identical. Casement and sash-cord windows (for instance) are operated and circulate breeze differently, but the experience of using them is just about the same.
Snodgrass (1990) describes how architecture can be used for religious and spiritual revelation
Jencks (1999) describes how architecture can thrill
But when it comes to healthcare design, architecture is rarely so focused on psychology.
Even though psychology is a branch of medicine...
-it becomes servant to its parts:
models of care
There are now thousands of studies that show how architecture makes a substantial difference to health outcomes. Most are incremental, and supported by abstract aetiological pathways like 'stress'.
The built environment plays a significant role in the
life and death of people.
Architecture can amplify emotions
Almost all healthcare interventions focus on manageability: the physical resources needed to keep us going.
a function of knowledge. It's about understanding why you're sick and how to get better.
Meaningfulness enriches and gives quality to life.
It's the sum of all the best reasons to keep living.
In different circumstances, salutogenic needs change.
Comprehensibility is more important (in the short term) than meaningfulness when 'things are looking bad', like after a heart seizure for instance. (Bergman et al 2012)
Sudjic (2006) describes how architecture can be used as a weapon
The most basic level of processing involves manageability. The formula is simple -
if it behaves like food, eat it;
if there's danger, flee;
if it's arousing, mate it.
INSTINCTIVE ACTIONS ARE EMBODIED IN OBJECTS.
These instinctive processes are mediated by
The mesecephalon -
the 'reptilian' complex in the centre of the brain.
Is a step more complicated. Because it involves
We draw together vast lexical epistemologies so that information is available when it's needed.
The temporal and parietal areas of the cerebral cortex (the outside layer of the brain) is used for associations: the links between bits of information.
These are drawn together by the limbic organs: the hippocampi and the amygdalae in the so called
The limbic organs monitor narratives.
The hippocampi 'hold' and comprehend story - the beginning, middle and end.
The amygdalae monitor 'ipseiety' - how much something is about 'me'.
These organs are duplicated, so we can handle multiple stories.
These link to the hypothalamus.
The hypothalamus is like a gateway.
As long as the 'story' is okay, the gate to automatic reactions remains shut. But
when things look beyond a reasonable threshold of control, the doors swing open, and reptilian processes like the fight/flight reflex takes control.
doesn't have to reflect the truth - it just needs to 'make sense' of sense data.
Delusional subjects usually have low SOC scores due to low meaningfulness and manageability quotas - not low comprehensibility.
The frontal lobe is rich with dopamine neurons. what differentiates human ones from those of all other animals, is that most of the human dopamine neurons in this region are of the excitatory D1 type, rather than the inhibitory D2 type. The difference is that a sense of awareness improves when humans can get excited by engaging in aesthetics, the subtleties of meaning and problems that demand deeper consideration.
Frontal processes create dopaminergic tone. This is expected to help with psychotic illness, affective illness (depression) and also with Parkinson's disease.
Frontal processes also inhibit automatic actions.
First up narratives are assessed.
If circumstances 'look right' then the 'free will' pathway is enabled. This changes the endocrine flow, allowing more oxytocin (a love hormone) and fewer anxiety compounds like cortisol. The free-will pathway also encourages a longer endocrine cascade, meaning that cholesterol can turn to useful hormones like Estrogen, Testosterone and DHEA.
A mud-map of the brain and its processes:
Each evolutionary iteration of the brain must process increasingly complex information. And like a computer, the more complex, the slower it is to work through. Reflexive actions are fast. Considered ones are slow.
But evolution doesn't favour slow reactions - so the brain has worked out a way of making quick, automatic assessments of what may happen based on previous experience. In other words 'stories'. The brain has evolved a hard-wired system to read narratives very quickly.
Some disorders that are directly affected by the
endocrine system include:
Some disorders directly affected by dopamine off-balance include:
Bipolar and Mood disorders
Can an environment be psychologically toxic?
The answer is
, but it depends on what the environment means to
A narrative of immense power was designed into the architecture of Albert Speer. This muscular form was salutogenically supportive to the Nazis. But it triggered a heart-attack for Dr. Hácha.
Dr Emil Hácha
First President of Czechoslovakia
amplifying emotions means endocrine and neural changes.
Architecture can be a powerful weapon.
But can it be an equally powerful ally?
To design to allow the body to heal itself, we should understand the hippocampi/amygdalae couplings:
When people are ill or otherwise vulnerable the story already reads as potentially bad, so automatic thresholds will be low.
Design must manage embedded narratives.
We must first convey the message of indisputable positivity: that everything's going to be okay.
Beyond that we can design to improve manageability, comprehensibility and meaningfulness.
People read TYPOLOGY first:
So if you're designing a hospital - you must first distance the style so it DOESN'T look like a set from a drama where patients get wrong diagnoses or die for dramatic value.
machines with alarms
An intensive care unit in Massachusetts General Hospital by NBBJ Architects
There are a number of exemplary hospitals that now bring the natural environment into patient spaces. These wouldn't be appropriate sets for HBO medical dramas.
: how to say
"everything's going to be okay."
: enrich meaning by connecting people with family, community and other things that matter.
Meaningfulness is maximised when one's attention (a dopaminergic function) is focused on things that are worth living for
- concerns beyond one's own self.
Meaningfulness is very personal, and is therefore difficult to design for in a multicultural society. But with a rich sense of meaning, people can do without the ordinary things that make life manageable.
Conventional medicine focuses on improving manageability and preventing death. But with
90% of the world's health budgets being spent during the last year of life,
that focus must change.
The salutogenic focus is on
supporting the factors that improve resistance
, and therefore on recovery.
A basement-level garden at Khoo Teck Puat Hospital, Singapore (CPG Consultants and Peridian Asia Landcapes)
A meercat enclosure in the ambulatory department of the Royal Childrens Hospital in Melbourne (Bates Smart, Billard Leece and HKS Architects)
A genuine hearth in the oncology (radiology) basement in Credit Valley Hospital, Canada by Farrow
Design exerts a behavioural and pharmacological influence through stage sets: by managing the story.
Qualia - the individual details may be major design decisions, but on their own, things like direction and colour just don't elicit comparable shifts (event potentials) inside the principle organ or perception:
What does are
, both past and projected.
is a step more complex again. The anterior lobe of the cerebral cortex swells to a distinctly neomammalian shape.
The main differences are that the anterior Caudial Cingulate and Prefrontal Cortex are particularly large in humans. These organs process insight, choice and actions for situations where there's no obvious responses: it's the 'creative organ'. And it makes us what we are - more human.
Not only are the (negative) automatic pathways bad for health, and emotions, but automatic actions are uninhibited, reflexive, and stereotyped responses that instinctively use all available opportunities.
As a dramatic example, in 2012, an English tourist was decapitated by a presumed schizophrenic in the knife-section of a supermarket in Tennerife.
The assailant held the victim's head aloft and yelled "Behold. I am the avenger of God."
But architecture can be genuinely
Can the environment trigger radical behaviour? Again yes, but it depends on which pathways
are being engaged. The frontal pathway
allows for creative use of space.
The reptillian one triggers
Design the environments so stereotypical responses are
life-affirming and benevolent.