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Mind the Design: Health and Illness and How they’re Affected

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Jan Golembiewski

on 19 August 2015

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Transcript of Mind the Design: Health and Illness and How they’re Affected

Mind the Design: Health and Illness and How they’re Affected by Healthcare Architecture
Prof. Jan Golembiewski (MArch,PhD)
The relationship between the mind and the environment is possibly more profound than the relationship between the mind and the body.
Rene Descartes,
1641 'no relationship'
This concept was embraced
by the Enlightenment and
medical science.
Juvenal, 200 AD
'healthy body = healthy mind'
Harlow, 1848 'the brain
determines behaviour' -
In this case even more than health
Skinner, 1938 - refuting dualism: a single body-mind-behaviour axis
JJ Gibson, 1978 'ecological perception': Perception = action
Why does this matter?
- because the brain is affected by the environment, and through the brain, mental and somatic health is also.

-Mental illness is diagnosed ONLY by behaviour.
Therefore the environment has a direct CAUSAL relationship with mental illness.
What stimulates attention?

1. Perceptual impact.
2. Meaning.

- When circumstances don't match learned expectations
- Violations of natural order (rhythms, colours, sounds, smells etc.)
These cause interrogation behaviour.

In most mental illness, dopamine supply to the inhibitory receptors increases. Meanwhile dopamine supply to the excitatory receptors decreases.

We want to rearrange, not change dopamine levels.
Tone is more or less continual, and low-level. It is likely caused by inhibitory receptors (D2, 3 & 4)
Spikes only happen periodically.
These are thought to trigger declarative attention. Spikes are usually a response to POSITIVE information (leading to dopamine / reward theory).
Perceptual impact:
What do we find meaningful?

1. Things I understand or have learned about
2. Things that affect me
3. Things that demand action
4. Things that affect those I care about

The urban environment is wholly designed: Each and every designed object is replete with meaning.

Nowhere are there more objects and events that demand attention. To some degree every crumb makes some kind of latent perceptual demand on us.

Phasis consumes 10 times more available dopamine.
The difference is in the way we react to stimuli:
With awareness or with automaticity.
The capacity to process story creates meaning.
And it is how the story affects ME that that will allow this 'healing' engagement - phasis to occur...

- This is unique for humans. Other mammals have mostly inhibitory receptors, even in their prefrontal cortices. Humans have mostly excitatory ones. This means humans don't just react to stories, we engage in them. And with stories we can predict events.

Stories that affect ourselves and people and matters we care about are the most important ones: but we want to see action - not helpless reaction.

People who are vulnerable are far more reactive to negative perceptions - especially those with severe mental illness - about 65 times more! (Golembiewski, Med Hyp, 2013).
Hippocampi (one on each side): narrative processing-shrinks with smi
Amygdalae (on each side):
ipseity proccessing - enlarges with smi.
We read narrative information all around us, but some places are richer with meaning (both good and bad).
And so it's the designer's job
to tell that story.

- Design with an unmistakably 'positive' lexicon: joyful, fun, natural, engaging, aesthetic.
- Design for positive stimulation
- Design out possible 'negatives'.
- In healthcare and for housing, design opportunities for perceptual respite.

What stories does your hospital design tell? (Be honest.)
ICU at Mass. Gen. by NBBJ Architects
Patient spaces at KTP by CPG Architects
Set for Grey's Anatomy by ABC (USA) - Emergency = Disaster.
Amb at RCH. by Billard Leece& BSA
This paper is really just a teaser.
Some of the materal has been published -
More to follow. Look on the web.

Jan Golembiewski
call me: 0424 936 263

- research in design and health at QUT
- available as an independent consltant.
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