Kitchenism in Mental Health Institutions

KITCHENISM IN MENTAL HEALTH INSTITUTIONS THE TRANSLATION OF THE IDEA OF KITCHENISM FOUND IN THE MAGGIE CENTRES INTO YOUTH PSYCHIATRY.

STUDIO CARE ARCHITECTURE

CONTENTS

TABLE OF CONTENTS / page 3 INTRODUCTION / page 4 CHAPTER 1: THE ARCHITECTURAL PLACEBO EFFECT / page 5 - 18 CHAPTER 2: KITCHENISM, A CASE STUDY: MAGGIE CENTERS / page 18 - 24 CHAPTER 3: AIMLESS KITCHENISM, DE KAAP: YOUTH PSYCHIATRIC FACILITY / page 24 - 33 CHAPTER 4: DESIGN AT DE KAAP: YOUTH PSYCHIATRIC FACILITY / page 33 -35

ARNE HAMAL STUDIO CARE ARCHITECTURE BY: GIDEON BOIE AND LAYLA LAVENS KU LEUVEN, 2020-2021

INTRODUCTION

I

n this document I want to put forward the idea of the beneficial effects the translation of the Kitchenism effect into mental health care architecture can have.

By considering that buildings like the Maggie Centers act as an Architectural Placebo

and thus have a positive contribution to the healing process of the patient. I want

achieve this by first placing the Maggie Centers in it’s historical context and thus illustrating the historical importance of the Maggie Centers by establishing all the defining factors that set it apart from regular, institutionalized care facilities.

Consequently I will zoom in on the two main causes that invoke the Architectural Placebo effect, the ethos of both the sense of community and

a non-institutionalized architecture

serving as the antithese of the hospital.

Working off of the hypotheses put forth in previous chapters I shift attention to the predominant architectural element that invokes both ethoses, the kitchen and put forward evidence as to why it plays a pivotal role in this theory by analyzing the Kitchenism, as Charles Jencks dubbed it, in the Maggie centers.

In the third chapter the attention will shift away from hospitals and towards mental health institutes and in particular introduce the youth psychiatric

facility de Kaap in Melle, Gent.

This to subsequently make a conclusion as to why the implementation of

the principles put forth would prove beneficial to both the Kaap and similar mental health institutes.

ARNE HAMAL

CHAPTER 1: THE ARCHITECTURAL PLACEBO EFFECT

INSTITUTIONALIZATION

T

he mentality for care architecture started to evermore shift away from the belief that the building should heal both body and mind culminated in 18th century architecture. It marked the point where the architecture of hospitals started to be fully submerged into a culture of power and rational thought. It became institutionalized and built as a tool for social control alongside schools and prisons. Edwin Heathcote notes in ‘The Architecture of Hope, Maggie Cancer Caring Centres’ that the architecture of such institutes was “characterized aesthetically by a somber combination of repetition and lack of ornamentation.”

The focus for care projects started to gradually shift more and more towards the industrialization of the care giving process; away from the patients.

Essentially the only parameter that counted in this age was the number of people a certain facility can hold.

On the left we can see the plan for the renovation of the Bedlam asylum designed by James Tilly Matthew where we can clearly see the transition of the hospital towards an institution is still ongoing. Where the building is aesthetically characterized by the repetition.

On the contrary, Matthew also proposed that the hospital should be a place where patients could tend gardens and do other useful work on the grounds. Which was in line with the ideology of the ‘moral treatment’, that emerged in the 18th century. It focussed mainly on a humane psychosocial care model developed in context of the enlightenment by John Locke.

1848

INSTITUTIONALIZATION

c

ontinuation of this idea is also seen in the 19th century and is accelerated by the consequences of the ethos of the first Industrial Revolution in the mid 19th century. It was characterized as a phase of rapid standardization and industrialization, which mindset was also distinctly visible in the architecture of it’s institutions, to which the hospital belonged since the 18th century.

To demonstrate this idea the Kirkbride plan is shown on the left. It is considered to be the leading plan typology in 19th century United States. These buildings tended to be large and imposing, defined by it’s narrow and stepped linear building footprint resembling the wingspan of a bat. And even though it was revolutionary because for the first time in history the mentally ill were not locked up but were believed to be able to heal from their condition.

The plan displays the mindset about the healing process architecturally as an apparatus. It does this by having each wing be divided into four different wards on each side of the administrative section of the building, which is located in the middle. Since these four wards were placed in a pattern, with the patients deemed most dangerous on the far sides of the building, in their own pavilion, and the more ‘stable’ patients closer towards the administrative center.

Which meant that as your mental health progressed, you’d gradually be moving towards the exit.

And even although Henry Ford’s assembly line wouldn’t be invented for another 20 years when this plan first appeared, the industrializing of the health care process, where people come in on one end and leave on the other, is both as striking as it is unsettling.

INDUSTRIALIZATION HEALTH CARE INDUSTRY

T

he transition off the hospital into an institution completed in the 20th century, where it truly lost all cultural meaning following the beliefs of the modernists.

Edwin Heathcote noted that “during the modern era, […] the hospitals became more machine than monument, a stripped-down, functional series of boxes accommodating the increasingly complex technical apparatus for prolonging life“. Following this transition the notion that a hospital should heal both body and mind was completely abandoned. The focus lay solely on the

hospital being equipped with the latest technology and most advanced medical techniques. Architecture, and some would even argue the mental wellbeing of a patient, became an afterthought.

This carried over into the 21st century where the focus remained on the machinisation of the hospital but where the architecture was now also focussed on the notion of sterile environments.

All hospitals had started to feel the same as you walked into them, as they all had the same white corridors lit overhead by white neon lights.

“…waiting in itself is not so bad - it’s the circumstances in which you have to wait that count. Overhead (sometimes even neon) lighting, interior spaces with no view out and miserable seating against the walls all contribute to extreme mental and physical enervation. Patients who arrive relatively hopeful soon start to wilt” Maggie Jencks, A view from the front line

fig. 01 / Interior view, Maggie center Cardiff, Dow Jones Architects

MAGGIE CENTERS

“ It says to the sufferer: your affliction is a normal part of life. Here is a haven where all of you may meet, share stories, and work on what is an essential part of life - not something to deny. It says to those who arrive for the first time: come in, you count” - Charles Jencks, Can Architecture Affect Your Health?

I

n the 21st century the awareness that a healthcare institute should tend to both mind and body is being renewed and has been exemplified by the Maggie Center hospices. Named after Maggie Jencks, these hospices are scattered throughout the UK and are always built on the site of a hospital.

Their goal is best described by Maggie Jencks, the namesake of the centers, in the architectural brief: “Among Maggie’s beliefs about cancer treatment was the importance of environment to a person dealing with cancer. She talked about the need for ‘thoughtful lighting, a view out to trees, birds and sky’ and the opportunity to ‘relax and talk away from home cares’. She talked about the need for a welcoming, reassuring space, as well as a space for privacy, where someone can take in information at their own pace.”. Immediately it stands out that the person behind the illness is brought into the spotlight. It is however important to note that none of these centers are a hospital, nobody receives any medical treatment. As a result of this it manages to be the complete architectural antithese of the 21st century hospital.

fig. 04 / Interior view, Maggie center Manchester, Foster + Partners

fig. 05 / Interior view, Maggie center Oxford, Wilkinson Eyre Architects

I

t manages to be this complete architectural antithese through 4 basic architectural principles: - Domesticity, giving a particular homelike scale to the centers, something which is constantly reflected in different aspects of the building, the materialization, the layout, the lack of signage, etc...

- Unexpected privacy, one of the less evident attributes of the Maggie Centers is in which manner they handle the privacy of their visitors. Even though the level of privacy is relatively high for an open center and thus comparable with a hospital in that sense, it has always been consciously designed. A clear example of this can be seen in fig 01 and fig 02.

Where OMA implements the level of privacy similar to that of the nearby hospital, but does so in a non-traditional manner by skewing each room away from each other and manages to create little private dens (middle image on the right).

- Constant connection with nature, the focus on external connection is not only present in every building, but also in almost every room there exists an opportunity to step out into nature and, be it in the form of a terrace or of an interior garden.

- The creation of the sense of community, invoked through the combination of the concept of Kitchenism and the 3 previous principles (indirect) which will be discussed in chapter 2.

(Alongside the care and attention all patients receive from the volunteers at the centers) Even though the undeniable positive mindset the Maggie centers bring in comparison with the traditional institutionalized hospital architecture, making the claim that architecture and art alone have the potential to save cancer patients would be inappropriate. Charles Jencks comments on this topic in ‘Maggie centers and the Architectural Placebo’ the following: “their psychological changes soon transform into social and physical ones. It is their mind over matter, because changes in the mind leads to shifts in behavior.”

This statement however isn’t as unlikely as over the last few years it’s become more and more apparent the influence the mind has over the body. Hence why the Maggie centers, by setting up an environment where people affected by the same illness can share their experiences, can be considered to positively affect a persons health and act as an Architectural Placebo Effect.

fig. 01 / Interior view, Maggie center Gartnavel, OMA

fig. 02 / Axonometric view, Maggie center Gartnavel, OMA;

fig. 03 / diagram, Maggie center Gartnavel, OMA.

CHAPTER 2: KITCHENISM, A CASE STUDY: MAGGIE CENTERS

Kitchenism: The kitchen as the social hub of every centre and the kitchen table as the focal point for social interaction; a place for people to sit, drink tea, eat biscuits, and converse around with a cup of tea in a proper mug, not a hospital-issued plastic cup.

K

itchenism is one of the most important aspects as to why the Maggie centres manage to stand out from the institutionalized architecture from the hospital. In a way it is the reaction to the hospital as the end product of the evolutions discussed in chapter 1 by focusing on the wellbeing of the person as a whole instead of only the disease. The Maggie centres provide a space to deal with the cancer diagnosis you’ve received and creates an opportunity for people in the same situation to meet. Maggie’s provides the visitor with a feeling of comfort, of being in control and manages to do so without being belittling in a time you need it the most. It makes you feel in control of your surroundings by being able to choose where you make yourself comfortable, what chair to sit in, what cushion to sit on, … it’s these small things that are so important to break the rigidity of “I have no choice, I have cancer”. It also does this by creating a focal point for the interactions in the building. By making the kitchen (table) the center of the building, a place to converge, and it’s been intentionally

designed as such by being the main hub of the building. Having the room to converge in serve a purpose that’s so universal (everyone needs to eat) makes it so that it serves as a reason, an excuse if you will, for people to be present in the room and converse with each other.

It draws people towards it through the function. The reasoning becomes clear when compared with a waiting room of a hospital, where the same people are sitting under the same circumstances, the only difference is the space they find themselves in. It isn’t hard to imagine the feeling of dread creeping upon you while sitting in plastic chairs half a meter apart from each other in a bright neon lit room waiting on your appointment.

Only to be dismissed immediately after the appointment is over. After just being diagnosed it’s also not possible to sit down for a while in the waiting room because at that point there is no reason to be there. In the Maggie’s however people are encouraged to come in and stay as long as they like. And this is possible because you are encouraged, through the function, to stay and talk when you need it the most.

“a long table where patients can drink a cup of tea or coffee. It is a place frequented at first as if there was nothing wrong, and later in which to release their fears and to find mutual comfort.”

- Laura Bossi in Domus, Special Issue: Wellness november 2018

fig. 01 / Interior view, Maggie center Nottingham, CZWG Architects

fig. 02 / Interior view, Maggie center Lankarshire, Reiach and Hall Architects

fig. 03 / Interior view, Maggie center Lankarshire, Reiach and Hall Architects

fig. 04 / Interior view, Maggie center Manchester, Foster + Partners

fig. 05 / Interior view, Maggie center Oldham, dRRM Architects

fig. 06 / Interior view, Maggie center Oxford, Wilkinson Eyre Architects

CHAPTER 3: AIMLESS KITCHENISM, DE KAAP: YOUTH PSYCHIATRIC FACILITY

F

or this chapter I want to continue with the principles learned in the chapters before, but to change perspective from health care towards mental health care and more specifically the case study of De Kaap youth psychiatric facility in Melle, Gent.

De Kaap is, with it’s 55 employees caring for 35 residents between the age of 6 and 17, the biggest department of the overarching Karus psychiatric hospital.

It finds itself under the supervision of Bart Wouters, Head of Department, with whom the interview was conducted.

Bart explains in his interview that they try to maintain a family like environment in his facility between the residents and points out that this feeling is mainly created in both the garden as in the communal space.

However hard this idea echoes with the findings of our previous chapters it is clear that when we look at the pictures the architecture doesn’t mimic this sentiment at all.

The upcoming chapters will therefore be dedicated to identifying what I will be calling aimless kitchenism in De Kaap and will be divided in three parts. First it will provide proof as to the facility itself recognizing the importance of the sense of community between its residents, but fails to translates this spatially. The second part will be about analyzing the current spatial translation of these needs and showing that the current situation a) doesn’t serve as the architectural antithese of a hospital and b) lacks the focussed concept of Kitchenism To end up in chapter 4 where a suggestion will be made to create a healing environment through the introduction of the symbolical kitchen.

IT’S DIFFERENT, IT’S MORE FAMILIAL AND WARMER. LIKE A BIG FAMILY. WE NOTICE THAT DURING THE LOCKDOWN THEY DIDN’T HAVE THE OPTION TO GO HOME AND THEY HAD TO STAY DURING THE WEEKENDS. THERE WERE 24 TEENAGERS LOCKED UP WITH THE STAFF FOR SEVERAL WEEKS, BUT WE NOTICED THAT IT BECAME ONE BIG FAMILY

INTERVIEW Bart Wouters, Head of Department at De Kaap, youth psychiatric facility.

c

ould you tell us about the residents?

Our department exists out of 4 living groups, 3 residential groups and 1-day hospitalisation. The youngest age is 6.

There is one group from the age of 6 until 12 with 7 children in this group. Then we have 2 parallel groups of the age of 12 until 17, with 9 children in each group. When they reach the age of 17 the have to move to another department on the campus.

The day hospitalisation holds 10 places for children of the age between 12 and 18.

SO YES THE CONNECTION WITH THE NATURAL ENVIRONMENT IS VERY IMPORTANT AND FOR THE MOMENT THE LOCATION IS NEARLY PERFECT. PEOPLE LIKE COMING TO WORK, BUT ALSO FOR THE CHILDREN AND FAMILY IT GIVES A GOOD FEELING SEEING SUCH AN ENVIRONMENT

They mostly have problems with going to school. They also have a lot of psychological problems like being anxious because of bullying in their home environment.

In the two parallel groups for teenagers we also have 3 places for crisis care. This is a place where they can stay for two weeks. The most patients that find themselves here are teenagers who have suicidal tendencies. On a daily basis we have 40 children and teenagers.

Do you believe that architecture can influence the mental health of the residents in such a way that it can aid in the healing process ?

Yes it can, I’m sure of that. There are colleagues that work in buildings in the centre with a lot of rooms but with no connections to the garden. In our case the

nature is all around and it affects both the patients and the workers health in a positive way. You can go outside, you can do activities outside, the children can play.

So yes the connection with the natural environment is very important and for the moment the location is nearly perfect.

People like coming to work, but also for the children and family it gives a good feeling seeing such an environment.

I read somewhere that health care architecture should do 2 things, maintain the connection with nature but also give the opportunity for the residents to form communities and to get a homey feeling. Do you feel that the building allows that ?

It can be better, but yes you see it also when the children leave, they are sad. At KAAP the environment is what is the most liked, they feel at home, safe and have a lot of possibilities to find their rest. We also had a project last year with the intention to make closed areas in the garden where they can stay away from the public areas. Because the problem for the teenagers is that they don’t have any place for privacy to distance themselves from the others for some time.

We tried to implement some tunnels made out of vines. Its always about finding a balance between control and autonomy. We give a lot of autonomy but it needs to be safe for everybody. It’s also about working with directivity versus empathy. They asked to have some space for they’re own in the garden but they know they also have to be controlled because there are certain behaviours which are wrong. There are teenagers cutting themselves. Self harming is one the problems in our department.

Which spaces are the most popular among the residents? Is it the garden or the living room or the communal space?

I think the garden certainly and inside the building I would say the big social space, where all the living rooms meet, it is the one place where they can meet each other and the teenagers from the other groups. That’s the most popular.

fig. 01 / Bart Wouters

I WOULD SAY THE BIG SOCIAL SPACE, WHERE ALL THE LIVING ROOMS MEET, IT IS THE ONE PLACE WHERE THEY CAN MEET EACH OTHER AND THE TEENAGERS FROM THE OTHER GROUPS. THAT’S THE MOST POPULAR. (...)

So you’re focusing on making the child safe from himself rather than making a safe environment?

You have to give them opportunities in their treatment to explore and find themselves.

That’s why we work this much with the group dynamic and we make the conscious choice to not put 6 or 7 children together that all suffer from an eating disorder. It creates the wrong environment; everyone will be focused on it and it doesn’t solve anything. When you have one person in the group that’s not willing to eat the others will surely comment on that, something along the lines of “come on eat something” and we find this approach to be working well.

So the residents are helping each other?

Yes certainly, they are the best therapists for each other, better than adults often. A child gives different perspective. We also work very much with the context, sometimes the problem is in the family and there are problems with the father or the mother and the behaviour of the child is a symptom of a sick family system. It’s often complicated.

How is this treated? Do you talk with the family?

Yes exactly, family therapy, with the parents, grandparents, brothers, sisters, everyone if necessary.

Is everyone open for that?

No, not at all. We try as much as possible; we’ve got a lot of clients whose parents have psychiatric problems and sometimes there is a lot of aggression in the family situation, alcohol problems, sometimes abuse.

I can imagine that it has to be frustrating as a caregiver to see the residents go back home over the weekend and watch them deteriorate?

Yes but unfortunately that’s how our society works, you have to leave the idea that you can save everybody. That’s not working, you try to make the best out of the circumstances, but the parents of the child will often not change so you have to make the teenager strong enough to survive in that environment and you will give him enough support from youth groups like the scouts so that he or she has enough support to survive in a sick family system.

fig. 02 / Interior view, De Kaap youth psychiatric facility.

AIMLESS KITCHENISM

T

he interview with Bart provides valuable insights into the workings of De Kaap and demonstrates the recognition of the valuable properties of harboring a sense of community has by the facility itself. Bart mentions several times throughout the interview how everything in De Kaap is evaluated in light of the ‘family feeling’ (for the sense of continuity this will be changed to ‘the sense of community’ but the same ideas apply on both terms).

For example, when asked if there are cameras placed in the facility the answer was: “No this wouldn’t be good for the family climate we try to maintain here”.

In general, two main benefits seem to jump out, Firstly, harboring a sense of community provides the residents the stable environment they need to start the healing process. Since the children in treatment are taught how to function in a group setting, they learn

to open up to both their peers and their caretakers and open up for therapy.

This also has an important long-term consequence, Bart speaks in the last paragraph about how it is crucial for the children to be strong enough to survive in a sick family system and that the children need to be able to fall back upon the support of another group.

Secondly, on a shorter term it also helps them working through their own troubles since the community is not only harbored by the caregivers but also deliberately constructed. Every child is sorted into groups by their problems and it’s made sure that an environment is set up where they help each other.

Even though the community feeling is created on multiple levels throughout their therapy I want to focus on the architectural translation and specifically the communal space shown in fig. 01, fig. 02 and fig. 03.

fig. 01 / interior view, De Kaap Youth psychiatric facility;

fig. 01

fig. 03 / floor plan, De Kaap Youth psychiatric facility;

fig. 01 / interior view, De Kaap Youth psychiatric facility;

fig. 02

fig. 04 / diagram, De Kaap Youth psychiatric facility;

fig. 05 / circulation diagram, De Kaap Youth psychiatric facility;

N

ow that the emphasis of De Kaap on the sense of community has been established we can start to analyze the existing spatial translation of it in the communal space. To make this analysis the 4 principles that applied to make a healing environment in the Maggie centers that were established in chapter 1 will be used.

Domesticity: as highlighted in fig. 04 it’s clear that both the furniture as the materials used for the communal space which are not typically found in a domestic setting. The overhanging neon lights in combination with the plastic chairs and their layout reflect a rather institutionalized style of architecture. (fig. 04 and fig. 06) Unexpected privacy: With the bedrooms directly giving out on the central space it’s easy for the caregivers to keep surveillance of the children.

However, it also leads to the fact that the children feel easily watched at all times because of the layout of the building. With the circulation circling all the way around the communal space the ideas of a ‘plaza’ and agoraphobia start to emerge as well (fig. 05).

Connection to nature: even though De Kaap enjoys an extraordinary location the communal space is surrounded by closed walls and doesn’t provide any possibility for a view outside or the option to step outside for a bit. The two roof lights do provide a well-lit area but are not sufficient because the lack of views. It has to be noted thought that the bedrooms do provide the connection with nature, which was commented on

by Bart as working exceptionally well.

Kitchenism: as discussed in chapter 2 kitchenism works because of the possibility to allow it’s user a certain degree of freedom. The choice where to sit and with whom or away from whom, it’s the small things that count in this instance. The feeling that you are in control of something is a very important aspect within Kitchenism and teaches the autonomy to the children.

The current communal space however feels rigid in its layout, moving one of the lounge chairs to the opposite side of the room for example looks like it is out of the question. The room also fails to provide the users an adequate reason to be there since a focal point is missing. It lacks ‘the symbolical kitchen’. (fig. 04)

fig. 06 / Material analysis De Kaap Youth psychiatric facility;

CONCLUSION As a conclusion we can state that De Kaap recognizes its need for the sense of community but forces this in a space without enough agency which also doesn’t serve as an antithese to institutionalized architecture while at the same time lacking a focal point, like the symbolical kitchen, to focus the interactions of its users. The attempts seem haphazard in a residual space and are seem therefore as an aimless effort at the integration of Kitchenism.

CHAPTER 4: DESIGN AT DE KAAP: YOUTH PSYCHIATRIC FACILITY

KITCHENISM IMPLEMENTED IN DE KAAP

In my opinion De Kaap is exceptionally well located for a youth psychiatry center but fails to take full advantage of this aspect and consequently makes do with the building they have. This means that an otherwise progressive facility which clearly understands its (and the children’s) needs has outgrown its outdated 20th century institutionalized architecture for a while now. Even though De Kaap facility recognizes fully the need for a family sense within its community the building inhibits them too much to architecturally translate this awareness spatially. This is why my proposition isn’t situated within the building, but on the grounds of the building. The architecture is domestic in scale and relies on sustainable materials such as pine wood and stone floor tiles. Design wise it’s imperative for the building to be readable in one glance, but still allow for opportunities to step out for a while into the secluded garden to isolate yourself from the group if necessary. Since this connection to nature is crucial as a means of

escape. Similar to the Maggie centers it introduces the element kitchen to focus the interactions between the children in one place with the kitchen table as the center of attention. Ever since the youngest years of a child’s life the family gatherings and discussions consistently take place while sitting at the kitchen table, it is intrinsically linked with the notion of dialogue between parents and children. This is why the role of the kitchen table would not only play to the strengths of bonding between the residents, but would also be the ideal setting for family members and their children in a family therapy session. Something De Kaap does routinely and considers crucial in the rehabilitation of the children.

By taking into account the aforementioned aspects and combining this with the introduction of Kitchenism into De Kaap I’m positive De Kaap will be able to successfully realize the spatial translation of both the needs of the facility and its residents.

fig. 01 / Implementation of Kitchenism, De Kaap Youth psychiatric facility;

fig. 02 / Diagram materials, De Kaap Youth psychiatric facility;