The Architecture of Hope? by Adam Savage

(Parkinson, 2016)

Special Thanks I would like to thank my supervisor Athena Moustaka for her dedicated support and guidance. Athena continuously provided feedback, encouragement and was always willing and enthusiastic to assist in any way she could throughout the research project. I would also like to thank Tanja Poppelreuter for providing advice regarding choice of topics, literature and assistance throughout every completed essay during the course of this degree. Without the support of these tutors the completion of this dissertation would not have been possible..

Contents Chapter 1 Narrative ..................................................................................................................................................... 1 Chapter 2 Introduction ................................................................................................................................................ 2 Chapter 3 Review of Restorative Architecture ............................................................................................................ 3-4 Chapter 4 The experience of Maggie’s Oldham .......................................................................................................... 4.1 Maggie’s Design Brief .......................................................................................................................... 4.2 External Perspective ............................................................................................................................. 4.3 Spatial Organisation ............................................................................................................................. 4.4 Landscaping ......................................................................................................................................... 4.5 Orientation on Site ................................................................................................................................

5-6 5 5 5 6 6

Chapter 5 Clinical Activities in a Domestic Setting .................................................................................................... 5.1 Domesticity in a Clinical Building ........................................................................................................ 5.2 Atmospheric Environments .................................................................................................................. 5.3 Privacy in an Open Plan ........................................................................................................................ 5.4 Building Use .........................................................................................................................................

7-10 7 8 9 10

Chapter 6 Conclusion ................................................................................................................................................. 11 Bibliography .............................................................................................................................................. 12-13 List of Figures ............................................................................................................................................ 14

CHAPTER 1

NARR ATIVE

Fig. 1. Maggie’s Edinburgh Centre (ArtUK, n.d.)

In May 1993, Maggie Keswick Jencks was diagnosed with terminal breast cancer and was given 3 months to live, she was only 52 years old. After being informed of her horrific news, Maggie and her husband Charles Jencks were moved out of their consultation room into a desolate, artificially lit, hospital hallway. Facing death in a windowless corridor trying to deal with … having two or three months to live gave Maggie an idea - why shunt people with cancer into miserable surroundings? The designer visioned a cancer caring centre, she described a room with a view and a library (Kellaway, n.d.) a beautiful environment where people affected by cancer could process the most unimaginable news and receive the necessary care and support difficult to attain in a hospital environment. She wanted a place that offered healing potential through its design, where people could meet and share with others in similar circumstances (Van der Linden, Annemans & Heylighen, 2016). Maggie believed that her condition was as difficult on her as it was on her family, therefore she created a new type of support, a place that could make the experience of cancer easier for everyone. Following this, the couple knew that it was now vital that modern health care facilities required updating as they saw that the notion of architecture’s healing influences had been lost and accordingly, they approached to reconnect this forgotten custom. The two spent the remainder of Maggie’s life composing the blueprint for her idea, procuring the help from several of their friends from the architectural world. In 1996, the first Maggie’s centre was opened in Edinburgh, only months after Maggie’s timely death. Since then, Maggie’s centres have been providing psychological and social support to cancer patients and their families within thoughtful, beautiful spaces (ArchDaily, 2019) designed by numerous ‘starchitects’ including Frank Gehry, Zaha Hadid and Alex de Rijke. The overall goal of a Maggie’s centre is to help the users feel comfortable, in a building that resembles that of a home. This is underlined in the opening page of the trust’s design brief where it states they are informal “domestic” buildings where people can draw on practical, emotional and social support when they need it (Maggies, n.d.). Highlighting that designing the building to feel like a home is the fundamental ambition for all architects delegated with designing a Maggie’s with the goal of creating outstanding architecture, stated to have the power to uplift people (Van der Linden, Annemans & Heylighen, 2016). These centres are about far more than just attractive structures primarily, Maggie’s centres aim to demonstrate that it is not pointless to care about design and highlight architecture’s significance as a component in healing.

Fig. 2. Windowless Hospital Corridor (Parr, 2015)

CHAPTER 2

INTRO DUCT ION This dissertation explores how and if architecture can influence a healing outcome, analysing the Maggie’s cancer caring centre in Oldham, Manchester and examining how the domestic design of the building aims to create a positive impact on the health and well-being of its users and if this can in fact, rejuvenate them and help to reduce their emotional stress and increase their depleted resources. It is worth acknowledging, that Maggie’s centres are designed to accommodate patients (and their families) with terminal conditions and although the building that they are experiencing can improve their wellness at the time of occupation, there is no evidence to demonstrate that these centres have the power to heal. This paper will explore the prospect that the Maggie’s centre function as an architectural placebo creating a positive contribution to a healing process in terms of the patient’s well-being and less about their physical condition. I will discuss topics including the concept of a Maggie’s centre and restorative environments, the importance of domesticity and attention to design components. Well-being, also known as wellness or quality of life refers to what is naturally valuable to someone. It is a vigorous state in humans, established by a sense of individual vitality and a need to undertake activities which are meaningful, engaging and which make

Fig. 3. Maggie’s Cancer Caring Centre, Oldham (ArchDaily, n.d.)

them feel competent and autonomous (Huisman, E., Morales, E., van Hoof, J., & Kort, H., 2012). Therefore, the well-being of an individual is ultimately what is good for them and what uplifts their spirit. Well-being in the urban environment is achieved through designing buildings with socially conscious systems and materials relying on the arts and science to stimulate wellness. The objective of this is to promote the harmonious balance between physical, emotional, cognitive, and spiritual well-being while regenerating the natural environment (“Wellness Architecture & Design Initiative Terminology, Definitions & Resources - Global Wellness Institute”, n.d.) Our quality of life is influenced by our physical surroundings as they’re an extension of who are as people. The built environment, when sensitively designed, can offer a sense of belonging for the individual, their families, and communities and for this reason can positively affect their well-being (Smith, Metcalfe & Lommerse, 2012). Recent trends in architecture have widened the scope beyond the medical approach of treating the sick, aged and disabled to the well-being of all people in their everyday environments (Smith, 2011) and there is now a growing recognition in architecture’s power to ameliorate the recovery of individuals in these environments. An example of this would be Maggie’s cancer caring centre in Oldham.

CHAPTER 3 Although, there still remains a lack of evidence to confirm whether a restorative environment can heal a user, it could be argued that the emotional impact of an environment can be determined by paying meticulous attention to its design features. Sensitively considering components including materials, colour, light, biophilia and architectural forms can contribute to a more positive atmosphere in a building. These separate components are identified as generators of architectural atmospheres (Martin, Nettleton & Buse, 2019) and the influences that these features have on its users are still being understood today. Harry Francis Mallgrave cites in his book From Object to Experience (Mallgrave, 2018). Today, the sciences have granted us the tools to help us understand … the precise ways in which the built environment can affect the building user’s individual experience. Through an understanding of these tools … prioritizing the experience of space - the emotional and aesthetic responses, and the sense of homeostatic well-being, of those who will occupy any designed environment.

RESTORATIVE ARCHITECTURE

REVIEW OF

Fig. 4. Florence Nightingale treating injured soliders during the Crimean War (The Conservationist, 2020)

The roots of the concept of a restorative environment dates back to the 19th century, developed in Florence Nightingale’s “Notes on Hospitals” where she outlined in detail the requirements of the sick room (Nightingale, 1859). The illustrious nurse noted its design needed to include quiet, warmth, clean air, light, and good diet as she believed this would minimize patient suffering and enhance their recovery period. Upon publishing this information in her treatise in 1859, early health care designs would follow her ideologies including Douglas Galton’s Herbert Hospital in Woolwich which Nightingale was said to have stated to be the best [designed] military hospital in the world (McDonald, 2020).

Research in environmental psychology in the 1980’s addressed the relationship between people’s wellness and the environment. Psychologists analysed the characteristics of restorative environments and identified that they can influence health outcomes, stating that the settings can act on people’s well-being through the immune system (Van der Linden, Annemans & Heylighen, 2016). A restorative environment is typically a natural setting, that can help to restore depleted attention resources by featuring components that encourage contemplation to provide a break from the individual’s normal routine (Beech, 2018). Therefore a restorative built environment should always aim to incorporate identical components.

This stresses the importance behind composing a carefully arranged environment and the impact that this has on its daily users. Arguing that when designed correctly, prioritising the configuration of the spaces, can provide positive responses which create a healthier and more comfortable environment for them, correlating with the notion that the emotional impact of an environment can be determined through its design.

Fig. 5. Central Saanich Research Centre incorporating generators of architetcural atmospheres (Pacific Truss, 2015)

Fig. 6. Biosphera office in Milan (WOW, 2019)

Australian philosopher Jeff Malpas also quotes in (Mallgrave, 2018) To live in an environment which has to be endured or ignored rather than enjoyed is to be diminished as a human being. The society which ignores this fact is at risk, for it is presuming too far upon human adaptability, drabness, confusion, and mediocrity make an imponderable but real contribution to the frustrations and depressions which produce stultified, sick, or apathetic citizens. Advocating that the environment in which you live in or use every day will have a profound influence on your well-being, positively or negatively. Malpas insinuates that if you ignore the impact created by a poorly designed environment, the human capability to adapt to their surroundings consequently manipulates the user’s individual experience, in this case negatively. This can support the philosophy of John Dewey, an American philosopher who believed that human beings learn through a ‘hands-on’ approach and that you must interact with your environment in order to adapt and learn. Dewey states in his book “Democracy and Education” as we shape our environments, our environments shape us. Our habitat is the locus of our habits (Dewey, 1916). This coincides with Malpas’ notion of the human capability to adapt to their surroundings and argues that the way the spaces are organised will greatly affect the user experience and consequently underlines that these settings will influence your emotions and routines.

(Mittelmark et al., 2017) underpins this concept, stating that people deplete adaptive resources in facing the demands of everyday life, and environments differ in the support they afford for renewal of depleted resources which articulates that people exhaust themselves due to their day-to-day responsibilities and that depending on the environment in which they expend these resources, determines how effectively they are or aren’t restored. Restorative environments do not only permit restoration, but also promote restoration, enabling faster, more complete recovery of depleted resources than environments that are relatively free of demands but which lack positive features (Mittelmark et al., 2017) This correlates with Dewey’s ideology that the environment that we inhabit is the catalyst for our emotions and if designed without sensitive consideration of its emotional influence can contribute to the depletion of attention resources. Therefore, arguing that a building or setting can create a positive or negative impact on its users and that this can be shaped by its design, supporting the notion that a restorative environment can help to reduce emotional stress or depleted resources when sensitively considering the generators of architectural atmospheres.

Fig. 7. Maggie’s Oldham Cancer Caring Centre Interior (ArchDaily, n.d.)

MAGGIE’S OLDHAM

4.1 DESIGN BRIEF

Maggie’s Oldham centre’s design is unique in its own special way and was conceived by one the world’s most engaging architects. In this chapter the centre will be dissected, analysing various of the influential components that contribute towards the goal of the building - creating a noninstitutional environment by designing at a much smaller, domestic scale.

DRMM’s design of Maggie’s Oldham centre is captivating, to say the least. The entrance is uncharacteristic for a health care building however Maggie dismissed the idea of a reception desk due to the institutional atmosphere that it contributes to. Alternatively, visitors are personally welcomed at the door and offered a cup of tea or coffee, demonstrating how the responsibility of the carers is to make the experience as welcoming as the building. Observing the building from street perspective, you would think that the centre is no more than Fig. 9. Entrance to the centre (ArchDaily, n.d.)

The Maggie’s design brief (Maggies, n.d.) lists several key design features in their architectural brief that they believe contribute to a successful cancer caring centre such as thoughtful lighting, a view out to trees, birds, and sky. This could argue that the trust believes that the effectiveness of the design of a Maggie’s is determined by paying attention to design details and that these will influence the emotional impact that the building creates, overlapping with the notion that the efficacy of a healing environment is established by paying attention to the generators of its architectural atmospheres and could also correlate with Florence Nightigale’s ideologies of the sick room. Fig. 10. The Central Garden (ArchDaily, n.d.)

a wooden box, possibly a swanky new-build home. However, upon entering the centre, you’re greeted by a surprisingly large open space; comprising a central garden encased in rippling glass, as if you’re observing a gigantic Alvar Aalto vase at the heart of the building. This not only brings the outside in but also provides you with a palliative connection with nature immediately as you walk through the door. This design feature is essential to the atmosphere created in the building as it provides you with a calm and friendly environment – one of the main objectives underlined in the design brief (Maggie’s, n.d.).

Fig. 8. Maggie’s Oldham Street Perspective (ArchDaily, n.d.)

Fig. 11. Open Floor Plan, Separted by Central Garden (ArchDaily, n.d.)

The trust insinuates that entering the building means that the individual is accepting their cancer and that they won’t enter the building if they feel intimidated. The large open space is essential in allowing the user to observe the whole building as they enter, helping to reduce any emotional stress they may be feeling and to begin their journey of recovery. In order to achieve the centre’s large open space, de Rijke planned the central area of the building to feature no walls. The interior is partitioned to create private spaces for individuals to withdraw to, as well as communal spaces, which enable the patients to feel part of the whole building at all times. According to Jencks (2010) privacy is key to the Maggie’s Centres, this is achieved in Maggie’s Oldham through the central garden that separates different zones and imaginative components that allow for adaptive space making such as privacy curtains and reflective areas. These allow for spaces to flow into each other naturally and provide secluded areas for reflection and stimulation which are vital for helping patients come to terms with their illness as stimulation can contribute to the optimism needed to be able ‘to relax the fences you built up’ and ‘come to terms with your fears’ (Van der Linden, Annemans & Heylighen, 2016).

4.3 SPATIAL ORGANISATION

Alex de Rijke, founder of dRMM and the architect behind Maggie’s Oldham centres unique arrangement, was tasked with designing a space that not only accommodates patients with the most unimaginable conditions but a space where people can come to accept their circumstances and find comfort in a more domestic setting. The large open configuration is designed to encourage users to explore and to evade any intimidating feeling that they may get upon entering the building. (Maggie’s, n.d.) states All too often the first time someone comes over to Maggie’s, that person is feeling both frightened and vulnerable. We know that it often takes three or four attempts before someone makes it through the door. It takes courage to come in … We have to make it as easy as possible.

4.2 EXTERNAL PERSPECTIVE

THE EXPERIENCE OF

CHAPTER 4

4.4 LANDSCAPING

Fig. 14. North Fcaing Ceiling to Floor Window Gazing out to the Pennines (ArchDaily, n.d.) Fig. 12. Steel Columns that Elevate the Building (ArchDaily, n.d.)

The orientation of Maggie’s Oldham could not be more intentional, with the living room area pointing north towards the Pennines in the near distance. The floor to ceiling window delivers a calming framed view of the grassy hills and is described by de Rijke as hope in a horizon (Moore, 2017). Furthermore, it could be speculated that the decision to place the centre overlooking the adjacent Longsite housing estate could contribute towards the overall goal of the centres design aimed at achieving domesticity. Overlooking a conventional housing estate could provide users with a more homely atmosphere as opposed to overlooking, for example, a waterfall surrounded by towering palm trees and little duckies paddling in the water. This minor detail, whether deliberate or not, may be beneficial for helping users to feel more at home and relaxed about discussing their condition and could potentially suggest that these features contribute towards an architectural placebo – operating on the beliefs of the patient, that they now feel as though they’re at home, not in a healthcare facility. Fig. 13. Hidden Garden (ArchDaily, n.d.)

The centre is located on the grounds of the Oldham Royal Hospital which some may argue contradicts the idea of a Maggie’s centre, as patients may still feel the institutional atmosphere when on the hospital site and this may contribute to additional stress for them, however the centres are still intended for the purpose of treating terminally ill patients and are therefore may be required to be situated on the hospital site. On the other hand, it could be argued that the impact of the contrast in going from the hospital building into the centre will be more influential for the individual’s healing process than if the building was located on its own site, away from any health care facility. By creating a space apart from the hospital, the user is able to distinguish the Maggie’s centre as an autonomous building.

4.5 ORIENTATION ON SITE

Maggie, a landscape architect, wanted nature to be a key design component of the Maggie’s Centres. The Oldham centre is unique due to the limited space on site, creating a challenging landscaping design for dRMM. In order to resolve this issue, the building is elevated by 6 slender steel columns giving the appearance that the building floats as well as concealing a hidden garden below. Framed by scented plants and different species of trees, one species in the garden catches the eye in particular. The birch tree, known as the first to come back after a disaster (ArchDaily, 2019). The incorporation of the birch tree conveys the symbolism in de Rijke’s design and highlights the architect’s intellectual attention to every minute detail. This amalgamation can also support the notion of the importance of considering every design detail in the building in order to contribute to an environment that can stimulate wellness. As well as demonstrating the importance of providing a natural setting for every Maggie’s centre.

CHAPTER 5

CLINICAL ACTIVITIES IN A DOMESTIC SETTING (ADF, 2017) calls attention to de Rijke’s non-clinical approach in designing the centre stating Alex de Rijke was determined to ensure that his building did not replicate any of the dehumanising flaws that he sees as exemplifying healthcare facilities in the UK. By both avoiding these tropes (i.e., suspended ceilings, vending machines, a general sense of anti-nature and blandness) and also by way of a distinctly user-sensitive approach to design that echoes that of the Maggie’s charity itself, the architects have created something wonderful. This highlights the level of care and attention to detail in creating a non-clinical environment that de Rijke focussed on in his design of the centre. The cite suggests that every detail has an unfathomable influence than for just the building’s aesthetic and that their objective is to contribute to an atmosphere that can positively impact the user’s quality of life. This also emphasises that these features, if not carefully considered or withdrawn from the building entirely, can promote a setting that negatively impacts the users and stresses the importance that the building has to be domestic, not clinical. Fig. 15. Kitchen island contributes towards the centre’s domestic aesthetic (ArchDaily, n.d.)

5.1 DOMESTICITY IN A CLINICAL BUILDING

The comprehensive objective of Maggie’s Oldham is to provide a setting that helps people suffering from cancer feel secure, relaxed, and comfortable whilst circumventing feelings that you could experience in a clinical environment. The way of achieving this is through domesticity. The whole design has to focus on domestic features that provide an atmosphere in the building similar to that of a home. The home-like arrangement creates an informal environment at the centre which allows individuals to come together and find the hope, determination, and resources that they need to cope with one of the toughest challenges any of us is likely to face (Maggie’s, n.d.).

Studies carried out in (Martin, Nettleton & Buse, 2019) interviewed numerous patients that had previously attended a Maggie’s centre. One patient, named Sharon, stated this is more of an emotional place for me to come, where I feel more in control of me rather than being a patient that’s having things done to, which is what the hospital and entrance say to me.

5.2 ATMOSPHERIC ENVIRONMENTS

This statement is indispensable when accentuating the importance of sensitively considering healthcare design features and the influence that this can have on your wellness, underlining the significance of designing the centre to be domestic. Moreover, this theory can be supported by de Rijke himself who states in (McManus, 2017) a Maggie’s Centre can be likened to a house; ours is a house full of surprises demonstrating his objective of designing Maggie’s Oldham to resemble a home environment. His motive behind this is echoed in (ADF, 2017) where de Rijke quotes The use of wood at Maggie’s Oldham is part of a bigger design intention to reverse the norms of hospital architecture, where clinical institutionalised environments can make patients feel dispirited. In wood there is hope, humanity, scale and warmth. Thus, exhibiting that design components in the centre were carefully integrated to contribute to the domesticity of the building, in this instance the timber materials promote this atmosphere. Additionally, Moore (2017) cites the rubble of the mortuary that used to stand here [on the site] is made into a landscape out of which pioneer species such as the birch grow – the first to come back after a disaster conveying the symbolism in the design of the centre and highlighting the intellectual attention to every minute detail. Consequently, this illustrates that every design feature in Maggie’s Oldham was amalgamated into the building for the purpose of positively impacting the user experience and that the building goes beyond “architecture for architecture’s sake” (“The architecture of hope: Maggie’s Centre, Oldham”, n.d.) corresponding with the perception that Maggie’s centres demonstrate that it is not pointless to care about design. Finally, this can also be reinforced by (ADF, 2017) again, who quote de Rijke, stating it was also an attempt to stand back from the pantheon of other Maggie’s Centres suggesting that the architect views the building about being less about form than content. This theory is strengthened when de Rijke continues to state “It’s quite a deliberate reaction to many of the others [Maggie’s Centres], which often rely on form. They tend to privilege the building as an object. Instead, this building is a somewhat humbler attempt at facilitating the service within it by paying meticulous attention to the details. Subsequently, reinforcing with the notion that the attention to detail in the building is a paradigm for the impact of the user experience and is a strong argument to emphasise the conception that paying meticulous attention to the generators of architectural atmospheres is exemplar when designing an environment intended to enhance a healing process.

Fig. 16. Use of wood throughout entire design of the cemtre (ArchDaily, n.d.)

Moore (2017) covers a lot of ground in terms of the general design of the Maggie’s Oldham and how particular components affect the user experience. However, one specific feature was highlighted that stood out above the rest

5.3 PRIVACY IN AN OPEN PLAN

A big, heavy curtain by the textile designer Petra Blaisse can be drawn along a looping track to make a room within a room, a soft lunar module with transparent circles for views outside. The fabric is mossy and yellowish on one side and silver and shiny on the other and depending how you pull it you can get either surface facing you. It’s practical, but it’s also pure joy. It is like the most beautiful hospital curtain you have ever seen. This illustrates one of the elements of the centre used for visual focus. It is stated by (Van der Linden, Annemans & Heylighen, 2016) that design features in Maggie’s centres are used to provide a visual focus … that makes the eye follow the patterns. This is said to assist with meditation, inspiration, interest, and above all stimulates your imagination which is essential for enhancing the user’s well-being as it is evoked that stimulation can contribute to the optimism needed to be able to relax the fences you built up (Van der Linden, Annemans & Heylighen, 2016). This could dispute that the textured curtain is meant to help the users to avoid the negative thoughts associated with their condition, through distraction. Consequently, helping to enhance their quality of life – the overall objective of the centre. This can also be strengthened by (“The architecture of hope: Maggie’s Centre, Oldham”, n.d.) who quote the design of the whole is intended to maximise the human capacity for positivity. Therefore, illustrating that every design feature incorporated in Maggie’s Oldham was premeditated and integrated for the purpose of rejuvenating the user, helping the reduce emotional stress. Additionally, Moore’s (2017) quote also touches on how the incorporation of the curtain allows users to separate open space into private space. Bernie Byrne, the centre’s head states sometimes, people

Fig. 17. Textured curtain by Petra Blaisse (Inside Outside, 2017)

tell you about their greatest fears in an open space, indicating that the curtain can be used to create a reflective area for the users. By providing this private zone, that can be modified based on user requirements, can also allow individuals to feel more at ease and possibly be more open to talk about their feelings. The simple alteration to the curtain, by using more abstract colours and materials and removing the dull and more plastic textiles, can enable the users to avoid feeling like they’re in a hospital environment, consequently helping them to feel relaxed in a building that they do not recognise. Bryne’s statement is also supported where (Van der Linden, Annemans & Heylighen, 2016) cites you can be on your own, but not alone insinuating that an open plan configuration can prevent isolation but still offer private spaces for users to withdraw to. Subsequently, highlighting that adaptable spaces in the building are essential to the spatial configuration of the building which could support the philosophy that the effects of restorative environments can be impacted based on sensitive consideration of design features.

Studies conducted in (Martin, Nettleton & Buse, 2019) investigated how the architecture of Maggie’s centres influenced the ways in which people would utilise the spaces. Staff members, patients and visitors of the centres were interviewed along with architects that were involved in current and previous Maggie’s centre projects. The research found that architects of new centres would conduct observational studies, early in their design process, analysing the ambience and routines of existing Maggie’s centres over the course of one week. This was in order to inform the plans for their own building. These studies demonstrate the level of consideration that architects take when designing a new Maggie’s centre and the thoroughness of their approach and underlines the attention to detail and sensitive application of the building design which in consequence relates back to the notion that the effects of a restorative environment can be determined by paying meticulous attention to the generators of architectural atmospheres. Moore (2017) labels Maggie’s Oldham as strange, stating The space is otherworldly but not alien. It could be bewildering, the last thing a Maggie’s wants, as it aims to be welcoming to people who might be shocked by their diagnosis, but the pull of the space brings visitors further in.

However, the statement in Moore (2017) opposes the centre’s objective suggesting that the building is otherworldly - like nowhere you have been before, which if anything, contradicts the domestic aesthetic of the centre intended to help the users feel more at home. Nevertheless, this argument can be resolved by David, an architect that had worked on a previous Maggie’s development, interviewed in (Martin, Nettleton & Buse, 2019). The architect noted Maggie’s has got a very diverse area that it’s got to cover, and the buildings got to cover that as well. He argued that in order to accommodate a whole variety of individuals at different stages of their treatment required a building that has never been seen before. Therefore, this could argue that the design of the centre will be bewildering as it is composed to assist every user at different stages of treatment and recovery and therefore will require an unorthodox or ‘otherworldly’ design. The domestic atmosphere is integrated to provide users with a sense of comfort and is aimed at enabling them to come to terms with their illness and enhance their wellness. In consequence, the building may seem confusing to visitors who are not undergoing cancer treatment as they will not be seeking the relevant support attained at the centre and as there are a comparatively small number of buildings designed to promote healing though its design could make the building seem even more perplexing.

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Fig. 19. Otherworldly characteristic of Maggie’s Oldham (ArchDaily, n.d.)

5.4 BUILDING USE

Fig. 18. dRMM architects conducting observational stuides of Maggie’s Oldham (Wood Awards, 2017)

This, in fact, could argue against the heretical design of the centre disputing that the building is unfamiliar and puzzling, coinciding with Maude’s (2017) quote the building is a place that you haven’t been to before. Though on the other hand, it could be debated that the centre is designed in this way to provide patients an escape from a hospital environment as the overall purpose of the building is to avoid a clinical atmosphere. Moore’s (2017) cite the pull of space brings visitors further in correlates with we don’t want any person finding an excuse to turn around and walk away (Van der Linden, Annemans & Heylighen, 2016) suggesting that entering the centre should require little or no effort and that by designing the building to resemble a home allows users to avoid the atmosphere of a clinical building and aims at attracting them inside.

CHAPTER 6

CON CLUS ION

Maggie’s centres have provided a revolutionary approach towards the importance of health care design and demonstrate the impacts created by architecture. The trust has established themselves as a caring organisation who accommodate hundreds of thousands of cancer patients and their families across the globe with somewhere to turn at an extremely difficult period in their lives.

Fig. 20. Demonstrating the positive atmosphere at the centre (ArchDaily, n.d.)

In terms of evidence-based research, it can be disputed that Maggie’s centres have the power to uplift the user’s spirit whilst in the building, which is incredibly powerful with helping them come to terms with their condition and to reduce emotional stress, which essentially is what a healing environment is designed to achieve. This is accomplished by designing the building to create a ‘homely’ atmosphere through sensitive consideration of generators of architectural atmospheres. Integrating domestic features such as, the central kitchen table or living room area allows the individual to escape the institutional ambience that they may experience in a hospital and enable them to feel safe and relaxed. Coinciding with the ideology that the emotional impact of an environment can be determined through sensitive consideration of its design features. Maggie’s Oldham centre may not physically heal you, however if it has the power to rejuvenate an individual even for just a brief moment then the centre has done its job. However, there are no studies to support that this influence maintains upon exiting the building which can demonstrate that the centre could be characterised in the category of placebo architecture as the effect that the building creates on its users only occurs whilst inside and that once the individual has left, the influence ceases. This theory can be supported by Charles Jencks himself, who insinuates in (Jencks, 2012) that the Maggie’s centres can act in this way stating architecture and art do not in themselves save cancer patients, but they can amplify the activity and ethos of an institution in a positive direction thus conveying that the design of the building can only influence a more positive conviction for the user. Patients do not leave the centre with a cure, although there is an argument that a healing environment’s responsibility is not to physically heal but to emotionally heal. Emphasising, that the relationship between architecture and healing is not forthright, as it is not the building that provokes healing, but the spirit of both the architecture and the users that is built into the Maggie’s centres and enhances the building’s influence to aid healing. In conclusion, the domestic architecture of the Maggie’s Oldham centre cannot cure cancer; however, it does provide a safe space for cancer patients to feel better about their condition and it could be argued that although the centre does not physically heal an individual, it can aid their quality of life. It can be said that the built environment has an impact on its users because we are influenced by our physical surrounding as they are an extension of who we are as people. However, there is still not an undemanding conclusion that can be established in terms of its influence in healing. It is also worth mentioning that successful architects usually hold a rather intuitive understanding in terms of architecture’s healing potential already, though this is not specifically stated in an elaborated theory in the practise or grounded in scientific research and therefore it could be argued that there is still a relatively inefficient suggestion to reinforce if these environments can in fact heal as the theory has rarely been reconnoitred, therefore more evidence-based research is required in order to strengthen this argument.

Fig. 21. The domestic features inside the centre that brings users together (ArchDaily, n.d.)

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Bibliography A material level of care – Maggie’s Centre, Oldham. (2017). [Blog]. Retrieved from https://www.architectsdatafile.co.uk/news/a-material-level-of-care-maggies-centre-oldham/ Architects Journal. (2017). Unsettling approach: Maggie’s Forth Valley by Garbers & James. The Architectural Review. Retrieved from https://www.architectsjournal.co.uk/buildings/unsettling-approach-maggiesforth-valley-by-garbers-james Dewey, J. (1916). Democracy and Education: An Introduction to the Philosophy of Education. Macmillan. Dijkstra, K. (2009). Understanding healing environments: effects of physical environmental stimuli on patients’ health and well-being. PLANNING AND DESIGN IN CRITICAL CARE, 24. Retrieved from https:// research.utwente.nl/en/publications/understanding-healing-environments-effects-of-physical-environment Dunlop, A. (2017). Unsettling approach: Maggie’s Forth Valley by Garbers & James. Retrieved 14 November 2021, from https://www.architectsjournal.co.uk/buildings/unsettling-approach-maggies-forth-valley-bygarbers-james Florence Nightingale - The National Archives. Retrieved 8 November 2021, from https://www.nationalarchives.gov.uk/education/resources/florence-nightingale/ Huisman, E., Morales, E., van Hoof, J., & Kort, H. (2012). Healing environment: A review of the impact of physical environmental factors on users. Elsevier. Jacobs, J., & Merriman, P. (2011). Practising architectures. Social & Cultural Geography, 12(3), 211-222. doi: 10.1080/14649365.2011.565884 Jencks, Charles and Edwin Heathcote, The Architecture of Hope, Maggie Cancer Caring Centres, London: Francis Lincoln Limited, 2010 Jencks, C. (2012). Can Architecture Affect Your Health?. Retrieved 5 December 2021, from https://www.goodreads.com/book/show/17667138-can-architecture-affect-your-health Jencks, C. (2015). The Architecture of Hope: Maggie’s Cancer Caring Centres. Frances Lincoln. Maggies. Maggie’s Architecture and Landscape Brief [PDF] (pp. 2-10). Retrieved from https://www.maggies.org/media/filer_public/e0/3e/e03e8b60-ecc7-4ec7-95a1-18d9f9c4e7c9/maggies_architecturalbrief_2015. pdf Maggie’s Oldham | dRMM Architects. Retrieved 12 October 2021, from https://drmm.co.uk/project/maggies-oldham/ “Maggie’s Oldham / dRMM” 03 Jul 2017. ArchDaily. Accessed 12 Oct 2021. https://www.archdaily.com/874795/maggies-oldham-drmm ISSN 0719-8884 Mallgrave, H. (2018). From Object to Experience. London, UK: Bloomsbury Visual Arts, Bloomsbury Publishing Plc. Martin, D., Nettleton, S., & Buse, C. (2019). Social Science and Medicine. York: Department of Sociology, University of York.

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Maude, R. (2017). ARCHITECTURE OF HOPE: MAGGIE’S CANCER CENTRE IN OLDHAM, UK BY DRMM. [Blog]. Retrieved from https://www.yellowtrace.com.au/maggie-cancer-centre-oldham-uk-drmm/ McDonald, L. (2020). Florence Nightingale’s Influence on Hospital Design, Hospitalism, Hospital Diseases, and Hospital Architects. HERD: Health Environments Research & Design Journal, 13(3), 30-35. doi: 10.1177/1937586720931058 McManus, D. (2017). Maggies Centre in Oldham [Blog]. Retrieved from https://www.e-architect.com/manchester/maggies-centre-in-oldham Mittelmark, M., Sagy, S., Eriksson, M., Bauer, G., Pelikan, J., Lindström, B., & Espnes, G. (2017). The Handbook of Salutogenesis. Cham: Springer International Publishing. Moore, R. (2017). Maggie’s cancer centre in Oldham: a balm for the senses. The Guardian. Retrieved from https://www.theguardian.com/artanddesign/2017/jun/18/maggies-cancer-centre-oldham-balm-for-the-senses National Accounts of Wellbeing (n.d). What is wellbeing? Retrieved from http://www.nationalaccountsofwellbeing.org/learn/what-is-wellbeing.html Nightingale, F. (1859). Notes on Hospitals (3rd ed.). London: Longman, Roberts, and Green. Nightingale, F. (1859). Notes on Nursing. London: Longman, Roberts, and Green Smith, D., Metcalfe, P., & Lommerse, M. (2012). Interior Architecture as an Agent for Well-Being. Journal Of The HEIA, 19(3), 1-8. Retrieved from https://www.academia.edu/2306848/Interior_architecture_as_an_ agent_for_wellbeing Sommer, R. (1974). Tight Spaces; Hard Architecture and How to Humanize It. Englewood Cliffs, N.J.: Prentice-Hall. Stichler, J. (2001). Creating Healing Environments in Critical Care Units. Critical Care Nursing Quarterly, 24(3), 1-20. doi: 10.1097/00002727-200111000-00002 The architecture of hope: Maggie’s Centre, Oldham. Retrieved 11 October 2021, from https://stories.designcouncil.org.uk/architecture-hope-maggies-centre-oldham/ Van der Linden, V., Annemans, M., & Heylighen, A. (2016). Architects’ Approaches to Healing Environment in Designing a Maggie’s Cancer Caring Centre. The Design Journal, 19(3), 511-533. doi: 10.1080/14606925.2016.1149358 Wellness Architecture & Design Initiative Terminology, Definitions & Resources - Global Wellness Institute. Retrieved 9 November 2021, from https://globalwellnessinstitute.org/initiatives/wellness-architecturedesign-initiative/wellness-architecture-resources/

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List of Figures Title Page - Parkinson. (2016). Breaking Ground at Maggies Centre Oldham [Image]. Retrieved from https://fparkinson.co.uk/2016/07/27/maggies-centre/ Figure 1 - ArtUK. Maggie’s Edinburgh [Image]. Retrieved from https://artuk.org/visit/venues/maggies-edinburgh-7013 Figure 2 - Parr, N. (2015). Artificial lighting, drab corridors, a London hospital [Image]. Retrieved from https://nicholasjparr.com/2015/04/29/artificial-lighting-drab-corridors-a-london-hospital/ Figure 3 - ArchDaily. Maggie’s Oldham / dRMM [Image]. Retrieved from https://www.archdaily.com/874795/maggies-oldham-drmm Figure 4 - The Conservation. (2020). Florence Nightingale: a pioneer of hand washing and hygiene for health [Image]. Retrieved from https://theconversation.com/florence-nightingale-a-pioneer-of-hand-washingand-hygiene-for-health-134270 Figure 5 - Pacific Truss. (2015). Wood as a Restorative Material in Healthcare Environments [Image]. Retrieved from https://pacifictruss.com/wood-as-a-restorative-material-in-healthcare-environments/ Figure 6 - WOW. (2019). ENJOY THE RESTORATIVE DESIGN OF BIOSPHERA OFFICE! [Image]. Retrieved from https://wow-webmagazine.com/enjoy-the-restorative-design-of-biosphera-office-milan-piazzabeccaria-4-18-april Figure 7 - ArchDaily. Maggie’s Oldham / dRMM [Image]. Retrieved from https://www.archdaily.com/874795/maggies-oldham-drmm Figure 8 - ArchDaily. Maggie’s Oldham / dRMM [Image]. Retrieved from https://www.archdaily.com/874795/maggies-oldham-drmm Figure 9 - ArchDaily. Maggie’s Oldham / dRMM [Image]. Retrieved from https://www.archdaily.com/874795/maggies-oldham-drmm Figure 10 - ArchDaily. Maggie’s Oldham / dRMM [Image]. Retrieved from https://www.archdaily.com/874795/maggies-oldham-drmm Figure 11 - ArchDaily. Maggie’s Oldham / dRMM [Image]. Retrieved from https://www.archdaily.com/874795/maggies-oldham-drmm Figure 12 - ArchDaily. Maggie’s Oldham / dRMM [Image]. Retrieved from https://www.archdaily.com/874795/maggies-oldham-drmm Figure 13 - ArchDaily. Maggie’s Oldham / dRMM [Image]. Retrieved from https://www.archdaily.com/874795/maggies-oldham-drmm Figure 14 - ArchDaily. Maggie’s Oldham / dRMM [Image]. Retrieved from https://www.archdaily.com/874795/maggies-oldham-drmm Figure 15 - ArchDaily. Maggie’s Oldham / dRMM [Image]. Retrieved from https://www.archdaily.com/874795/maggies-oldham-drmm Figure 16 - ArchDaily. Maggie’s Oldham / dRMM [Image]. Retrieved from https://www.archdaily.com/874795/maggies-oldham-drmm Figure 17 - Inside Outside. (2017). Maggie’s Center Oldham, UK [Image]. Retrieved from https://www.insideoutside.nl/Maggie-s-CenterOldham-UK Figure 18 - Wood Awards. (2017). Maggie’s Oldham Building [Image]. Retrieved from https://www.e-architect.com/manchester/maggies-oldham-building Figure 19 - ArchDaily. Maggie’s Oldham / dRMM [Image]. Retrieved from https://www.archdaily.com/874795/maggies-oldham-drmm Figure 20 - ArchDaily. Maggie’s Oldham / dRMM [Image]. Retrieved from https://www.archdaily.com/874795/maggies-oldham-drmm Figure 21 - ArchDaily. Maggie’s Oldham / dRMM [Image]. Retrieved from https://www.archdaily.com/874795/maggies-oldham-drmm

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By Adam Savage Third Year RIBA Part 1 BoS Architecture Student University of Salford January 2022