Urban Rehabilitation Creating Spaces to Heal and Transition to Everyday Life
Cristen Mabardy M.Arch 2020
Urban Rehabilitation: Creating Spaces to Heal and Transition to Everyday Life by Cristen Mabardy Bachelor of Science in Architecture Wentworth Institute of Technology, 2019 Submitted to the Department of Architecture in partial fulfillment of the requirements for the degree of Master of Architecture at the Wentworth Institute of Technology, April 2020
.......................................................................... Cristen Mabardy Author Department of Architecture
.......................................................................... Certified by Lora Kim Thesis Supervisor
.......................................................................... Accepted by Kelly Hutzell Director of Graduate Programs
Š2020 Cristen Mabardy. All rights reserved. The author hereby grants to Wentworth Institute of Technology permission to reproduce and to publicly distribute copies of this thesis document in whole or in part using print, digital, or other means now known or hereafter created.
Plagiarism Statement I, Cristen Mabardy, am aware of the academic standards for acknowledging non-original content through citation and other means of crediting sources. In compliance with the Institute Academic Honesty policy, this thesis does not explicitly or implicitly represent the work of others as my own, including written work whether copied verbatim or paraphrased, visual work whether directly reproduced or redrawn, or content prepared by a third party engaged in the selling of academic materials.
Signature................................................................................ Date................................................
Dedication
In loving memory of my mother, Theresa. You left this world way too soon. This one’s for you.
Acknowledgements I’d like to thank my mom for supporting me as much as she did, my dad for never letting me forget my potential, my sisters for always being my people, and the friends who have gotten me through these last five crazy years, especially this past one. Without any of you, this book and the goals behind it would not be possible. Thank you to the faculty who have not only helped me express my ideas throughout this thesis but my entire undergraduate and graduate careers: Michael Wolfson, Linda Weld, Lora Kim, Ann Borst, and Ann Pitt.
Keywords
Abstract
Recovery
By incorporating community and urban factors into
Reality Transition Community Integration Nature Healing Urban Connection Thresholds
a healing setting, the transition from recovery to the daily life of an individual is possible. This, overall, will benefit the lifelong commitment alcoholics have with becoming and staying sober. There is a strong disconnect during the period between recovery and returning to everyday life. This thesis develops a rehabilitation center that offers a series of thresholds: one at the urban scale that defeats the idea of isolated healing; the next at an architectural scale that contains program that relates to both the patient and the community. These transitional thresholds restore life back into recovery, making the healing transformation practical. In order to ensure a proper rehabilitation, there must be a sense of acknowledgement with both the components that are meant to heal as well as the urban environment. This issue of transition from recovery to reality is one that is currently impacting the relapse rates of alcoholism. The healing environment must entail all elements that will benefit the quality of life within the space they are inhabiting. These experiential aspects include thresholds of visual connection, materiality, and relation to urban context. All involve transitions between public and private spaces, interior and exterior boundaries, and exposure to light and landscape. Typically, similar facilities are often isolated, leading them into an even stronger disconnect back into society. It is important to incorporate community program to help progress patients back into their everyday life.
Table of Contents
1
Introduction Thesis Statement & Argument Setting Context Framing Narrative Audience Chapter Structure Closing
2
3
15 18 22 24 26 27
Literature Review Introduction
32
Observation
34
Aspects of Healing
36
Alcoholism Recovery
42
Spirituality
45
Quality of Life
46
Transition
48
Design as Research Architecture’s Influence Site Scale Analysis Access to Landscape Access to Light Balanced Quality Site Selection Programmatic Relationships The Transition
58 64 70 78 84 88 94 96
4
5
Outcomes Overall Proposal
110
Methods of Design
132
Transitional Thresholds
134
Critical Reflection To Be Continued Self-Evaluation
146 148
1
Introduction Thesis Statement & Argument Setting Context Framing Narrative Audience Chapter Structure Closing
Figure 00. Chapter 1 | Introduction
14
Thesis Statement Urban Rehabilitation: Creating Spaces to Heal and Transition to Everyday Life By incorporating community and urban factors into a healing setting, the transition from recovery to the daily life of an individual is possible. This, overall, will benefit the lifelong commitment alcoholics have with becoming and staying sober. There is a strong disconnect during the period between recovery and returning to everyday life. This thesis develops a rehabilitation center that offers a series of thresholds: one at the urban scale that defeats the idea of isolated healing; the next at an architectural scale that contains program that relates to both the patient and the community.
Argument Designing spaces for alcoholism treatment can create a feeling of separation from day-to-day life. This shift in a patient’s environment impacts the long term effectiveness of their well-being. The areas in which these healing spaces encounter often take on a character of sanctuary in comparison to the everyday life. The change, however, will include elements that are easily implemented in a variety of circumstances. Since the process of recovery from alcoholism is everlasting, it is important to recognize the factors that could impact one’s transition into reality. Not only should these areas provide comfort, but they should also incorporate both public and private means. Therapeutic architecture will be applied by involving natural elements throughout to highlight an individualized method of recovery. The areas formed will stimulate physical and mental reactions. This approach will then verify the autonomy within the space, relating back to the individualized lifestyle for every person, yet still connecting to the community at all times.
Thesis Statement & Argument
15
16
Chapter 1 | Introduction
Figure 01. “Rehab” to “Home”.
17
Setting Context What makes a space capable of healing someone’s
these people as ill as they are. Acceptance is vital to
health and well-being? Not only is it important to
this illness as it is often frowned upon within society.
realize what factors are scientifically proven to better
In order to have a successful facility for this branch
improve someone’s health, but it also key to identify
of diseases, it needs to be recognized with the same
the different elements between illnesses. The history
value as any other sickness. Alcoholism is one that is
of alcoholism is one that isn’t given enough attention.
most hard to understand. It is sometimes difficult to
This particular topic seems to be overlooked and not
see just how much it affects someone’s life. Once the
seen as something that’s worth many peoples’ time.
substance becomes addictive, the person really has
It is important to understand that alcoholism is in fact
no control over it. It is just as damaging as any other
diseases. No, it’s not cancer, and yes it could have
life-threatening disease and should be taken just as
been prevented. However, this type of illness still kills
seriously. People die everyday from it, yet it is not
people. It’s starts off as a choice but ends in uncon-
looked at with the same level of respect.
trollable tendencies that always leads back to bad habits.
This may have to do with the history of alcoholism. During the Middle Ages, drunkenness was normal
The environment in which one recovers in an alco-
among almost everyone. It was something that wasn’t
holism related facility in particular, needs to accept
just accepted but expected within society. Today,
Figure 02.
A meeting dating back to 1940, addressing the origins of Alcoholics Anonymous.
18
Chapter 1 | Introduction
Figure 03.
A graph depicting the level of worldwide drinking compared to the amount of deaths caused by alcohol consumption.
There is a very specific recovery process for people dealing with this type of illness. That is the Twelve Step Program. This process of healing involves a spiritual experience that has been proven to get people through their recovery in an individualized way. The series of healing is an intensive one. Patients go through this step-by-step process without any preparation or anticipation of knowing what to expect. It can be very rare to complete all twelve steps, especially in the short amount of time patients often have. As part of the patient experience, there is the very real issue of limited time. Because of money, patients don’t get all the care they require. Insurance is limiting in the health realm. This is why it is essential to make sure patients get the most out of their time at a facility. When entering back into the average daily life, a recovering patient may feel disconnected and somewhat lost. In order for them to have a smooth transition, it is crucial to begin those steps back into reality while they are still receiving care within the center. “Typically, relapse rates for drugs and alcohol are between 40% and 50%.”1 This is the effect of the disconnect between the “unreal” and the “real” life qualities that come along with entering a treatment center. Currently, a lot of recovery centers lack the ability to it is pushed onto us by businesses trying to make a profit. A majority of advertising nowadays involves addictive products, because marketing knows this is what will get our attention. The amount of alcoholic products that are portrayed in a positive manner is incomparable to the negative effects it has on our health. Drinking can be a very encouraging, upbeat activity. However, the impact it has on our long-term well-being, especially the addictive effects, is almost never mentioned.
provide a physical step-by-step process within their built environment. It’s all about finding ways that people live both in and out of a recovering facility. What are the relationships between the two, and how can they be incorporated all at the same time? Architecture has the ability to contribute to the overall healing process. Whether it has to do with implementing aspects that relate to the daily life, or creating spaces that allow ample access to natural elements and values that are all essential to recovering. 1 JourneyPure: Emerald Coast. From Drug Rehab Back to Life: How to Transition, 2019. Setting Context 19
Boston, MA When considering how location affects the overall recovery and well-being of a patient, a lot is taken into consideration. Different scales and typologies are studied, while keeping in mind both the benefits and possible negatives of all. Society often associates alcohol as a positive thing. However, many people don’t often see the negatives to it. Alcoholism is more common than what the average person comprehends. There are different levels to it that are frequently disregarded. Today, most rehabilitation centers involving alcoholic recovery are located in a rural setting. This is typically away from society, leading members and patients to feel isolated. There are many reasons for having this type of facility not as engaged with the community. However, what happens when they are done with their treatment and ready to return home? There are real issues such as health insurance which only allows for a certain amount of time (i.e. 30 days) for someone to receive care. After this period of short time, the patient has no choice but to go back to their “everyday life�. Through this thesis investigation, thorough studies are done in order to determine what setting would fit best for transitioning to reality. The end decision results in an urban environment. Yes, there are distractions and triggers. Yes, it may be overwhelming at times. However, these challenges need to be overcome as part of the recovery process. Boston, MA is well-suited for this task. Located in the heart of the city, near Haymarket, North Station, and the North End, this site has access to optimal resources to easily transition back to the daily life.
20
Chapter 1 | Introduction
Setting Context
Framing Narrative Alcoholism has played a big role throughout my
It took my mother’s sudden death to alcohol, to
entire life. Beginning when I was a young child, my
accept alcoholism as a disease. I too, along with
mother picked up drinking. Over the years, it got
most of society as a whole, believed that substance
worse, and my childhood was a constant battle
abuse shouldn’t be a priority in taking the time to
between her and the alcohol. It seemed like I always
heal these people. I looked at drug addicts and
had alcohol on my mind, even at just nine years old.
alcoholics, including my own mother, as less of a
Soon enough, my father gained full custody of me
person than myself. I definitely prejudged, and the
due to my mother’s behavior while under the influ-
negative connotations and stigma behind substance
ence. My relationship with my mother stayed pretty
abuse aren’t helping anyone. People are dying to it
close. However, as time went by, my resentment
everyday, and if there is a way to implement healing
grew. As I entered my adult years, things progres-
aspects throughout someone’s life, not just in rehab,
sively got worse. I began to find every reason pos-
then it’s worth the life it could save.
sible to avoid my mother. Any problem I had in life, I would find a way to blame it on her and the alcohol.
As a young, aspiring architect, I am able to see more
You could imagine this only added to her depression
clearly what current treatment facilities lack. With
and drinking.
my personal experience dealing with someone who suffered from substance abuse, I am able to con-
My mother was in complete denial of even having a
nect these spaces to what someone will then need
drinking problem up until the recent year or two. She
outside of the facility, back in their home. These
discovered that the drinking was immensely affecting
healing spaces aren’t necessarily all the same. The
her health, so she decided on her own to go to rehab.
aspects of healing vary depending on the individual.
During her time there, she did become sober for the
In order to raise awareness on the issue of discon-
first time in a long time. Although, she was only given
nect between recovery and reality, the spaces that
a month to stay because of the very real issue of
are designed must be customized to the needs of
health insurance limitations. A few months went by,
the individual. Everyone moves at different paces
and relapse came and went. Without knowing it, my
and need some elements over others. The spaces
mother was slowly killing herself. It eventually caught
in which we heal should be able to translate to our
up to her, and took over. Within a week after one of
particular lifestyles.
her relapses, she unfortunately passed away. It was not until she died that I realized how powerful this illness is. It was not until after she died that I even acknowledged drinking as an illness at all.
22
Chapter 1 | Introduction
“You can’t go back and change the beginning, but you can start where you are and change the ending.” - C.S. Lewis
Figure 04. Imagery of “Alcoholic�.
Framing Narrative
23
Audience To Patients,
To Architects,
People seeking recovery for substance abuse can
It is crucial that architects and designers take into
vary in the needs they require for their individual
consideration the facts behind substance abuse
process. Since a healing environment demands a
related deaths. Not only are people who suffer with
number of aspects in order for it to be successful,
this disease losing the battle everyday, but they
the spaces should be fit for different functions. While
have no where to turn to when they leave the treat-
incorporating natural elements that have been proven
ment facility they are placed in. As architects, it is
to advance the well-being of patients along any ill-
important to recogize the individuality of everyone’s
ness, it is also important to remind patients of the life
process of healing. It is important to deliver constant
after recovery. Recovery from addiction and alco-
support throughout the space. Finally, it is important
holism is a life-long one.2 Patients should constantly
to consider the opinions of the patients as well as the
familiarize themselves with the everyday life they
people helping the patients heal. Think about how the
once lived, and are going to live once again. When
space can benefit the lifestyles outside the facility.
too much time, or any time at all, is spent in a recov-
Be sensitive and call this illness the disease that it
ery center, it starts to become more of a “fantasy”.
is. Respect the level of care that these patients need
This is what makes the transition back into reality
to endure the life-long recovery they are about to
so difficult. The difference between recovery and
encounter.
“real life” is currently very conflicting, when in fact it should be as cohesive as possible. Daily life should be incorporated into recovery, because recovery becomes a part of life once someone has entered the life of substance abuse. 2 Al-Anon Family Al-Anon. Paths to Recovery: Al-Anon’s Steps, Traditions, and Concepts. Al-Anon Family Groups, 1997. 4-5
24
Chapter 1 | Introduction
To Families,
To Society,
For families of recovering patients, it is important
On the contrary, society tends to look at substance
for them remember that recovery isn’t done when
abuse as something that can be controlled. Sub-
the program is. People need the continued support
stance abuse recovery often gets overlooked,
outside of their treatment. For families, it is sometimes
because it is not seen as a necessity. There is so
hard to think of substance abuse as a disease rather
much stigma to substance abuse that it regularly
than a choice. This can result is resentment and not
gets pushed away, creating isolation. This then leads
wanting to help their loved one. An essential aspect
to inability to transition properly. Society needs to
to healing properly, is for the recovering person to
understand and respect this disease like any other. It
admit their wrongs to improve the relationships they
is just as life-threatening as natural illnesses, and just
had prior to addiction.3 Since there is so much bit-
as sad to those who are affected by the loss. Relapse
terness against the one who is ill, it is often hard to
rates are at an all time high, where we should all be
accept and trust the recovering person again. For
working towards lowering the amount of setback and
families, it is vital to remember that this is a sickness
increasing the amount of lives saved.
and cannot be controlled. 3
Al-Anon, 111
Figure 05.
Family is the most important audience for improving the process of healing.
Audience
25
Chapter Structure CHAPTER 2:
CHAPTER 3:
Includes a literature review in which depicts the
Encompasses analytical material on what makes a
overall process of healing for people in need of
healing environment successful. The inclusion of
substance abuse recovery. Behavioral observation
light and landscape is something that is essential
is considered while the implementation of healing
for a smooth recovery. Therefore, design tests are
aspects is covered in ways of analyzing natural
done based on different site scales to depict where
elements within a space. The overall topic of what
the optimal access to these elements would be. This
substance abuse is, is described in detail based on
chapter also involves background information on
the specifics behind that particular process of treat-
therapeutic architecture and the recovery process
ment. The issue of transition from recovery to reality is
of substance abuse as well as the levels of support
also addressed, as it is something that care facilities
needed for the life-long recovery.
currently lack.
CHAPTER 4:
CHAPTER 5:
Incorporates the overall proposal outcomes. This
Concludes thoughts and ideas based off of the cri-
includes the operation of criteria that was clearly
tiques that were made during the final thesis defense.
demonstrated. The content here includes final pre-
Some questions answered in this chapter include:
sentation work, encompassing highlights of the
“How would you revisit and build upon your out-
design process and possible methods that were
comes if there were more time?” “What other criteria
taken along the way. Here, it is seen how the main
might be introduced in any further advancement of
issue of this thesis is adressed, by representing final
this work?” “What are the implications for anyone who
drawings, and then analyzing them through diagram-
would pursue these issues in the future?”
ming and implementing people’s journeys through this facility in specific views.
26
Chapter 1 | Introduction
Closing The overall goal of this thesis is to raise awareness for a variety of people that have any opinion at all towards treatment centers for substance abuse, specifically alcoholism as it holds a greater stigma. The aim is to respect this illness as a disease itself and recognize the balance that is missing between recovery and reality. The transition period in becoming sober is crucial in the healing process. The aspects of healing and everyday life must coincide together in order for successful rates of lives saved from this awful sickness that is killing people everyday. If architecture can play a vital part in producing the environment that helps lifestyles adapt to each other, why not experiment with it? Designing facilities that improve the well-being of the patients in need can go a long way that continues outside of that physical environment.
Closing
27
Bibliography Al-Anon Family Al-Anon. Paths to Recovery: Al-Anon’s Steps, Traditions, and Concepts. Al-Anon Family Groups, 1997.
JourneyPure: Emerald Coast. From Drug Rehab Back to Life: How to Transition, 2019.
28
Chapter 1 | Introduction
Image Sources *Unless cited below, all images offered in this book were created by author, Cristen Mabardy. FIgure 01: Hart, Rob’t. Rehabilitation Centre Groot Klimmendaal. April 2011.
Figure 02: Alcoholics Anonymous Cleveland. Top 20 Oldest AA Meetings. 2019
Figure 03: Recovery News. Alcohol, Alcoholism, and the Impact on Your Health. Aug 2019. Figure 04: The Recovery Village.
Figure 05: An Encouraging Word. Our Holy Families. Dec 2018.
:
Accumulated Sources
29
2
Literature Review Introduction Observation Aspects of Healing Alcoholism Recovery Spirituality Quality of Life Transition
Introduction Renewing health in space is essential in any suc-
healing environment. The impact of design within this
cessful healing environment. With that, are compo-
style of facility is extremely important as it serves the
nents that include the overall healing process, the
basis of recovery. The individual patients’ outlooks
impact of the designed space, and the potential of
are crucial in order to have a successful outcome.
innovation. A more targeted area of study is the often
The space in which someone heals should be indi-
overlooked illness of alcoholism. This type of dis-
vidualized to their process, as it would increase the
ease is seen as very controversial on whether or not
ability to move forward into reality. Revitalization in
it should be treated with the same level of respect
healing can only happen if attention is brought to
as any other illnesses. The care facilities that people
it. Comparing alcoholism recovery centers to other
inhabit in need of recovery currently lack the ability to
branches of illnesses is necessary to be able to
transform the overall lifestyles of these individuals. A
discover the contrasts between each. The overall
lot of the failure of design comes from the disconnect
shift to reality is still the main ambition to healing. The
in transition from recovery to everyday life. This is one
recovery process for everyone varies. However, if the
of the main factors that needs to be implemented in
transition isn’t smooth, then the overall healing envi-
the healing process.
ronment did not do its job.
The aspects of healing involve many such as the “Twelve Step Process”, spirituality, and nature. These elements are more closely analyzed in order to determine the level of necessity for this specific type of
32
Chapter 2 | Literature Review
Figure 06.
Figure 07.
Groot Klimmendaal Rehabilita-
The setting of this rehab
integrating the indoors with the
to have optimal access
tion Center in The Netherlands
outdoors as much as possible.
center is situated in nature to it.
Introduction
33
Observation The research behind design offers many ways of
While considering the psychological effects of peo-
thinking. In Rosalyn Cama’s book, Evidence-Based
ple under the influence of addiction, there are many
Healthcare Design, she covers the ways someone
components that are often hard to understand. A
like a designer can look at how to renew a space.
recovering addict who is now sober and an employee
Improvements in a health related setting are often
at a recovery center, Justin Lever, describes these
thought about but never quite taken as seriously as
components as “three parts of the brain”. He goes
they should. Cama takes a psychological approach
on about trying to describe why addicts make the
to trying to achieve what actions need to be taken
decisions they do. Lever explains that the first part of
in order to enhance the healing environment. She
the brain asks itself if it wants to get high. The second
begins with the observation of human behavior.
part of the brain asks “what about my kids and my
The method of observation while determining the
responsibilities?” Finally, the third part of the brain
key factors to what works and what doesn’t within
says “I don’t care; I just want to get high.” This helps
a facility is essential. Not only is observation done
people better comprehend what addicts and alcohol-
within a space, but it is also done on human behavior
ics are going through with the disease of addiction; it
and interaction. Observing how someone interacts
is uncontrollable.3
with a physical environment is a key measurement tool to defining sometimes unconscious behavior that
3 Lever, Justin. Interview. Conducted by Cristen Mabardy, 27 October 2019.
is otherwise difficult to detect.1 The overall idea of observation on the psychological scale is also broken down into different forms. Determining the interactions within a physical environment can be critical to figuring out the unconscious behavior that can be hard to detect otherwise. In the book, Building the
Figure 08.
Recovering addict, Justin Lever, explains the three
parts of the brain that affect addiction.
Evidence Base, the author identifies that there are typically three forms of observation: casual, systematic, and participant.2 All of these types of inspection involve distinctive ways of analyzing that are key to creating ways of innovating new design based on a spectrum of components.
1 Rosalyn Cama. Evidence-Based Healthcare Design. John Wiley & Sons, 2009. 18-19 2 Building the Evidence Base: Understanding Research in Healthcare Design. The Center for Health Design, 2014. 19
34
Chapter 2 | Literature Review
Figure 09.
Observation of behavior is essential for innovation in design for healthcare.
“Want To Get High?”
“What About My Family?”
“I Don’t Care; Let’s Just Get High.”
Observation
35
Aspects of Healing There are many elements of design that relate to the
considerable difference within a living environment. It
aspects of healing. The space in which we inhabit
is the natural element that has been proven to con-
greatly affects our well-being and overall lifestyle.
tribute greatly to any and every healing process. It
The qualities of healing are frequently drawn out in
is a component that reduces stress, while allowing
the text, The Healing House: How Living in the Right
comfort and serenity.5 Finding different ways to admit
House Can Heal You Spiritually, Emotionally, and
light into a space is based on specifics. What direc-
Physically by Barbara Bannon Harwood. Light is
tion is the light coming from, and how does it influ-
often known as a key element for healing and better-
ence the space? Consider the natural light in design
ing one’s well-being. Harwood has proven that there
work done by Carlo Scarpa. In the Sculpture Garden
are impacts that natural elements have on our health.
within the Biennale Pavilion in Venice, the way light
She discusses the impact that “Seasonal Affective
is brought into the space is impacted by the geom-
Disorder” has on people not just in a recovering
etry he uses. Throughout the day, the light moves
aspect but in general. Harwood states that “Seasonal
indirectly, creating different uses for the light that’s
Affective Disorder is absolutely connected to the
provided.
amount of daylight an individual gets.”4 The essence of natural light is one that is frequently portrayed as a positive element. According to Design and Living by Jan Krebs, light is a quality standard that makes a 4 Barbara Bannon Harwood. The Healing House: How Living in the Right House Can Heal You Spiritually, Emotionally, and Physically. Hay House, 1997. 89
36
Chapter 2 | Literature Review
5
Jan Krebs. Design and Living. Birkhauser, 2007. 12 Figure 10.
Scarpa’s work with light
influences the function of space that light conveys.
Aspects of Healing
Figures 11 & 12.
The Maggie’s Center in Oldham emphasizes the natural light
that comes through the center of the building. Bringing light
into a facility like this allows for ultimate comfort and healing.
38
Chapter 2 | Literature Review
Aspects of Healing
39
When natural light is in consideration, the levels of ease are also analyzed. In Harwood’s book, the arrangement and comfort levels are discussed in relation to natural light. The question of what type of light should be used for what function is elaborated. She states that east light is often used for morning duties such as breakfast while west light is reserved for sunsets and evening beauty in Winter while wanting to be covered in the Summer.6 This gives a sense of direction on where spaces should be placed based on their function in relation to the type of light needed. Another example of work that deals with admitting light, for a more spiritual purpose however, is Le Corbusier’s La Tourette. Not only is light a critical aspect of this monastery, but so is the integration of landscape. Corbusier includes grass rooftops to create an architectural promenade to compensate for the green space that was physically covered by the building itself. Figure 13.
Figure 14.
Corbusier’s use of light
The use of color in lightwells
brings back nature to the
suppose to take.
direction and roof vegetation emphasizes the direction it is site.
When contemplating all natural elements, there is also the essential component of landscape. Landscape brings a different sense of reaction to a space. It involves the presence of more of the senses. When landscape is featured in a healing environment, the outcome has shown positive impacts. From The Wall Street Journal, Harwood discovered in a case study that patients who received tree views versus those who did not, had fewer hospital stays, fewer negative evaluations, and fewer pain relievers and complications.7 From seeing this evidence, it is indicated that even a little exposure to nature can go a long way 6 7
40
Harwood, 146 Harwood, 96
Chapter 2 | Literature Review
and that nature itself can play more than one role in
dwelling can be structured into zones where different
someone’s life. In the Audain Art Museum by Patkau
uses join together to form one untied space. The idea
Architects, it is clear that landscape is an essential
of program can be either separated completely or
part of the design. The way that trees are brought into
connected in ways that make sense for who inhabits
the interior, as well as light, brings people together
the space. Program should be livable, functional, and
providing a sense of community.
circulated. When observing the setting of a space, the surroundings must be taken into consideration.
In addition to natural light, Jan Krebs discusses how
If the interior space is sheltered from the outside
open space is another key factor when observing
world, then it’s protected from elements like noise,
successful, livable areas. Orientation of areas and
unwanted fumes, and danger.8 However, at what
function of a space is determined by the level of open
level is it necessary to protect a physical space?
space that is mixed with built space. The relationship
Likewise, how dependent does that space become?
between these two types of spaces is important in
The idea of independence is one that is often consid-
recognizing the function and value overall. When
ered within a healing and overall living environment.
identifying the function, it is important to recognize
When comparing forms that are attached versus
how the overall structure works. For example, a
detached, it becomes clear which spaces are physi-
Figure 15.
Figure 16.
Corbusier adds landscape to
Natural elements are crucial
space” from the built space.
by using it as an attention
the building to make up for “lost in the Audain Art Museum
seeking factor for visitors.
cally seen as independent. From there, the question of at what level should these spaces be integrated based on the needs of the inhabitants? 8
Krebs, 60 Aspects of Healing
41
Alcoholism Recovery The needs within a space depend on who is occu-
steps by sharing them with others.9 Applying these
pying them. For a healing environment specifically,
ideas to the daily life may seem simple, but the pro-
requirements vary. There are countless components
cess is never-ending. Reminding patients that their
that contribute to recovery, but which ones are nec-
recovery is an on-going cycle is essential, especially
essary for an alcoholism related scene? For this type
since they have to re-enter reality right away.
of disease, there is a very strict procedure to healing. In the book, Paths to Recovery: Al-Anon’s Steps, Tra-
According to Improving Healthcare through Built
ditions, and Concepts by the Al-Anon Family, there is
Environment Infrastructure by Michail Kagioglou and
a very specific method of healing. This Twelve Step
Patricia Tzortzopoulos, the way the internal setting
Process is one that has been implemented mentally
of a healthcare environment changes, the more the
and spiritually for patients looking for treatment. The
patient is impacted. Changes have a lot to do with
principles these steps embody are universal and
the overall well-being of the patient. It is crucial that
applicable to anyone; reliance on wisdom to apply
the transitional step is taken seriously while in a
them to our lives. These steps suggest four primary
healthcare facility as it is what influences the patient
ideas: we are powerless to problem of alcohol, we
the most. A different approach to healthcare is being
can turn our lives to power greater than ourselves, we need to change attitudes and actions, we keep the
42
Chapter 2 | Literature Review
9 Al-Anon Family Al-Anon. Paths to Recovery: Al-Anon’s Steps, Traditions, and Concepts. Al-Anon Family Groups, 1997. 4-5
taken based on the transition to new technologies and demographic trends. The way clinical staff interacts with patients is also constantly changing because of the advances in medical procedures and use of technology.10 The ways in which medical techniques take place in a recovery process must interact well with the patients in order to create a smooth transition. Not only do the physical therapeutic techniques need to be considered, but also the mental and emotional aspects. According to Al-Anon, through the process of healing in a rehabilitation setting, spirituality is key. It opens up a level of awareness that patients need in order to even begin their path to recovery. As much as spirituality may be conceptual, the physical environment should translate it in some way, allowing personalized identification within space. Admitting the Figure 17.
Alcoholics Anonymous is a
part of the recovery process
Figure 18.
Each component of healing has their own individual
that involves group meetings to aspects that make the pro-
enhance the support needed for cess more understandable healing.
to the average person that is recovering or not.
wrongs of oneself during recovery is essential as it impacts the way one sees oneself. It affects whether or not someone is willing and wanting to change their lifestyle for the better. Ways of improving contact with God and spirituality of any kind, means having access to it. Being able to find quiet time in the environment in which you live is crucial but can be quite difficult. Does it become easier when the setting is more isolated? What would the process include if the setting was more urban? Getting to a place beyond your thoughts through meditation requires extreme concentration and focus.11 10 Michail Kagioglou, and Patricia Tzortzopoulos. Improving Healthcare through Built Environment Infrastructure. John Wiley & Sons, 2010. 47 11 Al-Anon, 111
Alcoholism Recovery
43
Spirituality A connection to spirituality is an essential part to recovery. As expressed in Harwood’s book, the qualities of home and the role it plays in healing oneself are covered in various ways. A home is a place where one can feel most comforted. It requires aspects that no other setting can provide. The idea of “home”, however, can be transformed into a specific environment to inform healing. In Harwood’s ideas of qualities that are suited for a healing environment, she brings up the aspect of silence. Silence allows us to center ourselves and have a sense of peace and, “If you have no time for silence in your life, you can have no healing.”12 Relating back to Al-Anon’s Twelve Steps, quietness is a crucial part of recovery.13 It permits spirituality to come through even in chaotic settings. According to Harwood, an environment that heals our spirits should also be in a place that is as close to its original, natural, and untouched state. It should be a place where natural elements should be as present as they can be.14 While incorporating both spirituality and nature into one space, these components may initially seem disconnected from each other. However, they can both work together and simultaneously in gaining the same end goal of healing. In the Maggie’s Center located in Oldham, England, the building does just that. This design seeks to provide “architecture of hope” where safe and welcoming spaces involve nature growing through the building. Nature does not stand alone and shouldn’t as it has many impacts on many different things. 12 13 14
Harwood, 106 Al-Anon, 111 Harwood, 63
Figure 19.
The Oldham Maggie’s Center incorporates nature as their
centerpiece for healing, much like spirituality is the centerpoint for the recovery process for substance abuse.
Spirituality
45
Quality of Life Adaptability is something that is the most challeng-
This concept is often questioned when looking at
ing when entering a healing environment. Unlike a
the types of care facilities. Most commonly, there
home, a recovering center often lacks the ability to
is inpatient care and outpatient care. In Carol Gal-
comfort someone in ways of making it easy to famil-
bicsek’s article, Inpatient Rehab for Alcoholism, she
iarize themselves within a space. When recovering,
compares the difference between the two kinds of
there’s a lot on the mind. The environment in which
care treatment options. A large factor of difference is
one is healing should be smooth and adjustable to fit
the environment in which someone lives. Outpatient
their specific needs. Harwood explains that a space
care allows someone to live at home, or outside of
should be able to “grow” with its occupants. It should
the treatment facility, while still receiving the care
not be static as people change throughout not only
they need. This treatment tends to be for less intense
their recovery process but their lives in general.15
cases of substance abuse recovery. This treatment
If the space is made for an individual with certain
also allows someone to feel comfort with little to no
needs, how will it be used down the road for some-
adaptation because they are living at home within
one else with complete opposite needs? How can the
their own lifestyles. On the contrary, inpatient care is
spaces adapt to the people’s adaptations, rather than
for more severe cases. It requires long-term stays at
the other way around? 15
Harwood, 50
Figure 20.
The Sodra Alvsborg Hospital enforces the same level of quality in group spaces as in individual spaces by incorporating
46
Chapter 2 | Literature Review
extensive amounts of nature.
facilities where someone is watched 24/7.16 The care
interpret them architecturally is the current challenge.
is more forceful, making the experience less com-
Along with the qualities of comfort that is a key com-
fortable. Both options of care are valid, but how can
ponent in a living space, there are also improvements
they relate to one another so the benefits of both are
to be made in safety, effectiveness, patient-cen-
portrayed without the negatives?
teredness, timeliness, efficiency, and equity that are needed in design innovation.19 These factors are all
Accommodation is all about consideration. In a
crucial in improving healthcare facilities all around.
substance abuse related setting, there’s a number
The quality of life within a living space requires devel-
of requirements needed for patients. Some of which
opment on multiple levels.
include physical individual spaces as well as assembly spaces for larger meetings. Harwood suggests
It’s important to consider factors that come off as
that in order to accommodate everyone, their must
more abstract when innovating these healing environ-
be appropriate spaces for each individual. A space
ments. The effect of color is one that is not frequently
should allow for group activities as well as privacy for
thought of in relation to the psychological sense. It is
individuals.17 An example of architectural work that
normally only represented for aesthetics rather than
incorporates both individualized and group spaces
having a viable purpose. Harwood highlights the
is the Sodra Alvsborg hospital. This building remem-
effects of color within a space. It leaves one thinking
bers the important healing factors in public and pri-
how color can potentially impact someone’s mood
vate areas. This particular notion is especially import-
and/or well-being. She states that the cooler colors
ant in a healing environment that requires a routine
of blues and greens are often useful for resting areas
based process. As Al-Anon implies how important
for relief and ease. Spaces that require comfort and
the step-by-step process is for recovering alcoholics,
a communicative presence should include the colors
the need for definite programmatic areas is essential.
that are closely related to peaches and pinks. Finally,
The Twelve Step process involves a lot of reliance on
spaces that are in great need of light, particularly nat-
one another. Therefore, the need for group settings
ural, should embrace whites and yellows to enhance
is essentially required.18 Not only are specific spaces
the level of brightness.20
taken into account when designing healing facilities,
19 Building the Evidence Base: Understanding Research in Healthcare Design, 32 20 Harwood, 99
but also the overall quality improvement aims. There are certain goals in design that seem like they are essential in improving healing spaces as pointed out in Building the Evidence Base: Understanding Research in Healthcare Design. Figuring out how to 16 Galbicsek, Carol. “Inpatient Rehab for Alcoholism.” Alcohol Rehab Guide, 24 July 2019. 17 Harwood, 52 18 Al-Anon, 3
Figure 21.
The individual patient rooms in the Sodra Alvsborg Hospital remain at the same level of quality based on the amount of access to natural elements.
Quality of Life
47
Transition When reflecting back on what is needed within a space in order to properly recover, it is important to recognize what the components that are also a part of everyday life. A lot of elements that we don’t necessarily think about as often as we should, could be extremely beneficial in a healing environment. In order to create a smooth, successful transition back into reality for a recovering person, they must be reminded of what life is like outside of the structured facility they are so used to. Since Al-Anon brings up how the disease of alcoholism is a lifetime commitment to recovery, it is crucial that “life” is brought into the space of treatment.21 Without daily life experiences, how would someone adjust after they’ve received the care within a limited time frame? Currently, there is a treatment plan that involves “sober living”. This is a type of living that patients encounter after they have received rehabilitation care. However, it isn’t that different from the strictly controlled environment they were previously in. In the article, Successfully Transitioning from Sober Living into Life Again, by Transcend: A Recovery Community, the author describes sober living as a modality rather than a lifestyle. This type of living specifically refers to a facility and not reality.22 This notion of fantasy versus reality is evident in current examples of recovery centers that lack the ability to provide a transitional step. According to the article, From Drug Rehab Back to Life: How to Transition, by JourneyPure: Emerald Coast, the fundamental tips to transitioning include steps as simple as creating time for reflection and developing a positive mindset, all the way to slowly returning to obligations that were 21 Al-Anon, 4-5 22 Transcend: A Recovery Community. Successfully Transitioning from Sober Living into Life Again., 2018.
48
Chapter 2 | Literature Review
Concern Disconnected Denial
Adjust Accept Renew
Fantasy
DURING
Adapting
During vs. After Care
Withdrawing 100
Too Comfortable Old Habits Fall Back
50
0
Receive Care
Relapse
Patients
AFTER
Reality New Beginning Excitement Risk
Figure 22.
This diagram represents the on-going cycle that a recovering patient goes through inspired by the ratio of relapse rates compared to the received care rates.
Transition
49
Figure 23.
The location of this recovery center
impacts the recovery after the treatment
plan, as it is extremely isolated from society making it hard to
adjust back to reality.
essential prior to recovery. The idea of routine is such
everything except for nature and the community
a strong component in the healing process within
within itself. The capability of transition seems hard
a treatment center that should continue outside as
when the disconnect to urban context is so strong.
well. In order to have a positive shift to everyday life,
When entering back into day to day life, there are
there has to be an understanding of expected chal-
certain dimensions that relate to both life and recov-
lenges, a well-balanced lifestyle, and an establish-
ery. In the article, 8 Essential Life Skills for Adults in
ment of support as well as commitment to sobriety.23
Recovery, by Eudaimonia Recovery Homes, the four
All of these factors of transition wouldn’t be possible
are health, home, purpose, and community. These
without self-awareness. In Transcend’s article, there
scopes entail being able to make healthy decisions,
is an emphasis on the importance of self-reliance and
having a safe and stable place to live, taking place
community that is included in sober living, but forgot-
in meaningful activities, and having access to social
ten about when entering reality.24
support.25 The aspects of home are important to remember as pointed out in Harwood’s book, that
A recovery center that lacks the ability to relate to the
“home” has healing effects of its own. It is something
“real world” is the Green Mountain Treatment Center.
that heals us spiritually and requires a level of stabil-
This facility is located in the extremely rural town of
ity.26
Effingham, NH where it is isolated from just about 23 JourneyPure: Emerald Coast. From Drug Rehab Back to Life: How to Transition, 2019. 24 Transcend
50
Chapter 2 | Literature Review
25 Eudaimonia Recovery Homes. 8 Essential Life Skills for Adults in Recovery. 2018. 26 Harwood, 63
La Metairie is a stationary clinic that hosts a stable environment for patients but does not seek any connection to society at all. It is calm and protected, but it is strictly fenced in by trees, hiding itself from anyone not belonging to the facility. One aspect that it succeeds in is the level of symmetry in its layout. The symmetrical components influence patients to live in a routine based setting, which is extremely helpful for the healing process.
Figure 24.
Figure 25.
The idea of symmetry inspires
The setting of this Swit-
tine in their everyday life at the
focused treatment, but it
patients to have a sense of rou- zerland clinic is ideal for treatment facility.
remains very cut off from
the rest of the world by the fence of nature.
Transition
51
Conclusion Narrowing down the improvements to be made all
recovery and reality.29 After looking at existing treat-
over the design intent for healing spaces, the focus
ment facilities, this disconnect comes from the lack of
varies. Attention should be drawn to individual needs
personalized lifestyle that is brought into these facil-
based on their own process and requirements for
ities. Without a sense of individualization, the hope
treatment. Patients seeking care should be given
for permanent sobriety is gone. The overall process
optimal options in order to fit their lifestyle as much as
for recovery is different for everyone. However, it is
possible. For example, as Galbicsek reiterates in her
possible to bring all these methods into one environ-
article, the important differences between inpatient
ment where spaces can then communicate with each
and outpatient care are crucial to discovering what
other, leaving patients feeling like they have some
works best for individuals.27 The traits of healing are
level of control within their own process of healing.
also components that vary depending on the individ-
The amount of components that go into a healing
ual. Harwood thoroughly discusses in her book how
atmosphere to make the most of it seems endless.
certain elements can affect the well-being of some-
Nevertheless, that does not mean it can’t be success-
one in different situations.28 The issue of disconnect
ful. By incorporating what each patient needs individ-
between recovery and reality derives from a number
ually will benefit the environment as a whole. While
of issues. In the scholarly works from Transcend,
evaluating architecture’s role in recovering, it can
JourneyPure and Eudaimonia Recovery Homes,
sometimes be difficult to determine how influential it
lifestyle is examined in order to determine how to
can really be. We should now question the impact
bridge the currently missing connection between
that architecture has on our healing environment and the transition period back to reality.
27 Galbicsek 28 Harwood, 96
52
Chapter 2 | Literature Review
29
Transcend, JourneyPure, Eudaimonia Recovery Homes
Figure 26.
The first form of rehabilitation
in the U.S. was created in 1750.
While recreational drinking was introduced, and as time went on, people became addicted.
Tribal leaders tried to encourage members to route back to their heritage and religion to guide them back to sobriety.
Conclusion
53
Bibliography Al-Anon Family Al-Anon. Paths to Recovery: Al-Anon’s Steps, Traditions, and Concepts. Al-Anon Family Groups, 1997.
Barbara Bannon Harwood. The Healing House: How Living in the Right House Can Heal You Spiritually, Emotionally, and Physically. Hay House, 1997.
Building the Evidence Base: Understanding Research in Healthcare Design. The Center for Health Design, 2014.
Eudaimonia Recovery Homes. 8 Essential Life Skills for Adults in Recovery. 2018. Galbicsek, Carol. Inpatient Rehab for Alcoholism. Alcohol Rehab Guide, 24 July 2019. Jan Krebs. Design and Living. Birkhauser, 2007. JourneyPure: Emerald Coast. From Drug Rehab Back to Life: How to Transition, 2019. Kagioglou, Michail, and Tzortzopoulos, Patricia. Improving Healthcare through Built Environment Infrastructure. John Wiley & Sons, 2010.
Lever, Justin. Interview. Conducted by Cristen Mabardy, 27 October 2019. Rosalyn Cama. Evidence-Based Healthcare Design. John Wiley & Sons, 2009. Transcend: A Recovery Community. Successfully Transitioning from Sober Living into Life Again., 2018.
54
Chapter 2 | Literature Review
Image Sources *Unless cited below, all images offered in this book were created by author, Cristen Mabardy. Figure 06: Hart, Rob’t. Rehabilitation Centre Groot Klimmendaal. April 2011. Figure 07: Hart, Rob’t. Rehabilitation Centre Groot Klimmendaal. April 2011. Figure 09: Imperial College London. Effective note-taking. 2019.
Figure 10: Seier. Carlo Scarpa, Architect: Biennale Sculpture Garden, Giadino Delle Sculpture, Venice 1950-1952. Sept 2012.
Figure 11: de Rijke, Alex. Maggie’s Oldham. July 2017.
Figure 12: de Rijke, Alex. Maggie’s Oldham. July 2017.
Figure 13: Schapochnik, Fernando. AD Classics: Convent of La Tourette/Le Corbusier. Figure 14: Ludwig, Samuel. AD Classics: Convent of La Tourette/Le Corbusier.
Figure 15: Schapochnik, Fernando. AD Classics: Convent of La Tourette/Le Corbusier. Figure 16: Jeskova, Justa. Audain Art Museum. 2019
Figure 17: Lopez, German. Why some people swear by Alcoholics Anonymous — and others despise it. Jan 2018
Figure 19: de Rijke, Alex. Maggie’s Oldham. July 2017.
Figure 20: White Arkitekter. New Psychiatric Clinic. 2013 Figure 21: White Arkitekter. New Psychiatric Clinic. 2013 Figure 25: Clinique La Metairie. 2018
Figure 26: Faden, William. The Roots of Rehabilitation. 2014
Accumulated Sources
55
3
Design as Research
Architecture’s Influence Site Scale Analysis Access to Landscape Access to Light Balanced Quality Site Selection Programmatic Relationships The Transition
Architecture’s Influence
Figure 27.
Infographic representing the components of Therapeutic Architecture in healing.
Figure 28.
A diagram showing the
meaning behind each individual step of the “Twelve Step” process references
by Al-Anon’s Paths to Recovery.
58
Therapeutic architecture involves several elements that have been proven to help the process of any healing process. This type of architecture depicts how each component can be used to benefit the person in the best way possible. The Twelve Steps is a healing process most commonly known to benefit those in need of substance abuse treatment. This step-by-step process is one that spiritually guides someone into restoring the parts of their life that have been broken by addiction and alcoholism in order to move forward.
Chapter 3 | Design As Research
Architecture’s Influence
Figure 30.
1785
“Sober houses” were created by Founding Father, Benjamin Rush. He found that alcoholics could be placed in these houses until they could safely return to back society.
Figure 29.
A timeline showing the overall history of alcoholism in the U.S. taken from the “History of Rehab Facilities”.
1750
1785
1840
“Sober houses” created by Founding Father, Benjamin Rush.
60
Chapter 3 | Design As Research
Dr. Keeley creates “secret formula” to try and cure alcoholism.
New York State Inebriate opens;
Small community groups begin to form.
First form of rehabilitation in U.S.
1850
Lodging homes open; First Inebriate home opens in Boston, MA.
1864
1867
The Martha Washington Home in Chicago, IL becomes first rehab for alcoholic women in U.S.
1879
Charles B. Towns Hospital opens where treatment was $350/day.
1890
Inebriate homes close and alcoholics are sent to drunk tanks, wards, and insane asylums.
1901
Prohibition; Failed attempt at limiting alcohol.
1919
Morphine maintenance clinics are created to treat people with morphine addictions.
1920
19
Narcotics farm vides free treatm and alco
Figure 31.
1935
Bill Wilson and Dr. Bob Smith founded Alcoholics Anonymous. This was the creation of the 12 steps which includes mental, emotional, and societal rehabilitation.
Bill Wilson and Dr. Bob Smith find Alcoholics Anonymous; 12 steps est.
935
opens and proment to addicts oholics.
1935
AA memberships surpasses 90,000.
1945
National Committee for Education on Alcoholism launched by Marty Mann, the first woman to complete 12 steps.
1955
Halfway House Association is founded.
1956
American Medical Association declared Alcoholism as an illness.
1960 1958
1964 National Institute of Mental Health establishes National Center for Prevention and Control of Alcoholism.
Mental Health Parity and Addiction Equity Act is passed that requires insurance companies to provide similar benefits for mental health and/or substance use treatment.
Secular Organizations for Sobriety and Rational Recovery are founded to emphasize rational decision-making, not spirituality.
Insurance industry begins to reimburse treatment of alcoholism.
1975
Government decentralizes substance abuse rehab and turns decisions over to states.
1985
1994
2008
SMART Recovery is founded; A non-12-step program focused on self-empowerment thatteaches skills of self change, helps people cope and manage thoughts, feelings, etc.
Architecture’s Influence
61
Metaire, LA
Philosophy Aim to povide “service culture” that ensures personalized healthcare
Reaction Patient flow is excellent; space is uplifting, calming & reassuring
62
Chapter 3 | Design As Research
Seattle, WA
Philosophy Coordination of care;committed to innovation
Reaction Size & “Cluster Concept” feels more like healing setting
Quincy, MA
Philosophy “Recreating their service”; oriented towards prevention life-long care
Reaction Peaceful, caring people; healing environment due to employee involvement
Inner Grove Heights, MINN
Redford, MI
Bridgeview, IL
Philosophy
Philosophy
Philosophy
Treating staff equally; concerns cause solutions
Emphasis on healthy lifestyle
“Continuity of care”; efficient, comfortable setting to promote healing
Reaction
Reaction
Reaction Serene & calming; countryside & views are appreciated
Gives secure & confident feeling; “Large windows make it bright and comfortable”
Comfortable surroundings with a good team; natural light is soothing
Figure 32.
A comparison between different health
facilities depicting their philosophies and
opinions towards what makes it a success-
ful healing environment. Architecture’s Influence
63
Figure 33.
Exploring the relationship be-
tween the built and unbuilt spaces. In a high density setting, one of the bigger issues when trying to integrate nature is the lack of light due to the overpowering shadows from skyscrapers.
64
Chapter 3 | Design As Research
Site Scale Analysis Chicago, IL Placing a rehabilitation facility in a denser urban
them. When looking at the inaccessibility factor of this
area becomes more difficult. Chicago is a very built
type of facility, is a high urban scale better or worse?
city where green space is even more limited. When
Should rehab facilities be more apparent to society
it comes to providing outdoor space to patients, it
instead of hidden away? Does part of the healing pro-
may need to be more on the private side. Whereas in
cess really include that level of isolation? Or is it just
this city setting, the green space available is mostly
prejudged into being put away solely from humiliation
public. Within the gridded blocks of Chicago, the
that alcoholism brings?
only relief to the buildings is the streets that surround
Figure 34.
A diagram referencing the grid of Chicago as well as the amount of landscape the city has access to.
Site Scale Analysis
65
66
Chapter 3 | Design As Research
Kendall Square, MA This semi-urban scale site is essential to discovering the balance between high density and low density. What are the pros and cons of each setting? With this Kendall Square location, the amount of built vs. open space seems equalized. There is a high level of program with the relief of space. Placing a rehab facility here would integrate it more within a related urban scale. It places patients within society while still having the privacy they may need. The amount of green space still might be limiting, but there is potential for it on other extents. The access and ability to nature gets a little more difficult in this setting but it can be done.
Figure 35.
Model that discovers the balanced level of built and unbuilt space in this semi-urban scale.
Figure 36.
A sectional diagram analyzing the built versus unbuilt space in Cambridge’s Kendall Square.
Site Scale Analysis
67
68
Chapter 3 | Design As Research
Figure 37.
A figure-ground laid
over an existing rural recovery center to
show the openness
and community within itself.
Figure 38.
A built form to analyze what programmatic elements could be
formed in “unbuilt” spaces.
Effingham, NH A rural setting is where most rehabilitation facilities
patient. This site in rural New Hampshire houses the
are placed for the sole purpose of seclusion. When
facility “Green Mountain Treatment Center” located
analyzing what it is a person would need within their
in the town of Effingham. It is a recovery center that
living space in order to have a smoother healing
specializes in drug and alcohol addiction that has
process, nature and access to the outdoors is reiter-
plenty of access and involvement with the outdoors.
ated. The use of natural elements such as fresh air
However, because it is so isolated from every part of
and light are components of therapeutic architecture.
society, this may affect the insight one may have on
It is important to incorporate this scheme throughout
accepting their addiction and overcoming it.
a healing environment to better the overall recovery process while still considering the well-being of the Site Scale Analysis
69
Access to Landscape While testing out the levels of access to landscape
explained further, the relationship between the inte-
throughout different scales, the relation to integration
rior and exterior begin to show how they can be used
starts to be represented in another way. As land-
for testing out different programmatic uses as well.
scape and other natural elements are essential to
This relationship starts to form a “blurred” element.
healing, it is also important to remember the larger
The balance within treatment facilties now is miss-
issue of life after recovery. By incorporating the
ing. It is crucial that we as designers find the miss-
program of recovery and everyday life, the transi-
ing pieces in order to have a successful rate of well
tion to life becomes smoother. With certain methods
patients after their time within the care center.
Figure 39.
Looking at Groot Klimmendaal Rehabilitation Center’s use of landscape integration. This
facility located in The Netherlands is a prime example of
how landscape plays a role in recovery.
Figure 40.
Analyzing Patkau Architect’s use of materiality and how it helps assist direction to the landscape integration here,
by creating a threshold within itself.
70
Chapter 3 | Design As Research
Access to Landscape
71
Figure 41.
Exploring the access to land-
Urban
scape within a high urban scale.
Site scales of different sizes were analyzed in order to determine the availability to landscape while still considering the level of integration with society. In one highly urban area, the compressed space limits the amount of nature that is able to be let in. However, this type of setting allows for a great connection to society.
Semi-Urban In a semi-urban setting, the access to landscape increases slightly while still implementing adaptation with its surroundings. This is a balanced approach to what an essential environment for healing should be.
72
Chapter 3 | Design As Research
Figure 42.
Exploring the access to land-
scape within a semi-urban scale.
The access to landscape can vary depending on the level of density the area is situated in. For more urban filled locations, the design intent must become more creative in order to bring landscape within. Currently, designers find it hard to be able to integrate natural elements in more compressed spaces, leading there to be a lack of any interaction with nature at all. Figure 43.
Comparing the orderly form of
the interior space to the free from of the exterior space.
Access to Landscape
73
Rural
A rural site has the ideal access to nature. Nonetheless, the level of isolation it portrays leaves patients feeling completely separated
74
Chapter 3 | Design As Research
from everyday life.
In a more isolated setting, like a rural scale, the access to landscape seems endless. With nature surrounding a built space, the possibilities for integration are unlimited. This could be why most recovery retreat centers are located in a space of this scale. Not only does it separate the patients from society, but it amplifies the amount of natural elements they have access to. However, the negative of isolation outweighs the positive of access to nature.
Figure 44.
Exploring the access to land-
scape within a high rural scale. Figure 45.
A diagram showing how natural elements could be integrated throughout.
Access to Landscape
75
Figure 46.
Diagram configuring spaces that
integrate with each other starting to form their own function.
Figure 47.
Analyzing what else this “push
and pull� effect could potentially benefit. Not only does it portray
the relationship between indoor and outdoor, but also recovery and reality.
76
Chapter 3 | Design As Research
Access to Landscape
77
Access to Light The same concept for landscape is applied for light. Light direction clearly changes throughout the day while also depending on the surroundings of the space. The level of open, or unbuilt space, around the built space affects the level of light let in. This can greatly impact the way the healing environment is meant to function. Figure 48.
Using Maggie’s Center Oldham to find a way of bringing light into a space in which could
assist in a spiritual setting for certain program.
Figure 49.
Analyzing Carlo Scarpa’s use of light and how it captures a
space and how people interact with it by the space it forms.
78
Chapter 3 | Design As Research
Access to Light
79
Figure 50, 51, & 52.
Diagramming light from three different directions within the same urban scale.
Figures 53, 55, & 57.
Diagramming light from three different directions within the same semi- urban scale.
Figures 54, 56, & 58.
Diagramming light from three different directions within the same rural scale.
80
Chapter 3 | Design As Research
Access to Light
81
Figure 59.
An abstract diagramming
level of access to both light and landscape.
82
Chapter 3 | Design As Research
Figure 60.
Another abstract looking at how landscape is always integrated while keeping
a systematic approach in mind.
Access to Light
83
Balanced Quality
Figure 61.
An image showing the
integration with nature in multiple ways.
84
Chapter 3 | Design As Research
Individual Spaces The value of the spaces within a healing environment strictly depends on the contact with the natural environment. In personal spaces, like a patient’s room, it is most commonly known to keep them as private as possible. This notion leads designers to almost completely cut them off from nature with little to no light. Privacy doesn’t always have to mean ample seclusion. There should be a balance between privacy and accessibility. Not only is the access essential, but also finding ways to make sure a person does not feel isolated as if they’re in a cell. With treatment centers like these, it is sometimes hard for people to feel as if the place they are staying is treated with the same level of value. This can make it feel unworthy and not as welcoming as public spaces. Figure 62.
An image showing the
integration with nature in a single, yet more impactful way.
Balanced Quality
85
Group Spaces In spaces where numerous people gather, there
ensure this routine, natural elements that maintain the
seems to be a higher value of life. This same “quality
well-being of patients should be apparent throughout.
of life� aspect should be applied to every space that
Stability is crucial to any recovery setting, and natural
occupies active function. Without the essential heal-
elements help support that mentality by creating the
ing elements being provided throughout, the space
connection to the outside world of healing . The cre-
lacks continuity. A continuation of specific elements
ation of stability within an environment is done by the
throughout a space provide a sense of routine, which
balanced approach of quality. When the quality within
is essential for substance abuse recovery. In order to
spaces is equalized, they become stable.
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Chapter 3 | Design As Research
Figures 63 & 64.
A section and perspective dia-
gramming the incorporation of nature that is centered around
group-functioned spaces in the Maggie’s Center of Oldham.
Figures 65 & 66.
A plan view and perspective di-
agramming the incorporation of nature that is centered around group-functioned spaces in
the Groot Klimmendaal Rehab Center of The Netherlands.
Balanced Quality
87
Site Selection Located in Boston, MA is a current substance abuse recovery center situated in a semi-urban area. This space is perfectly centered near Haymarket, North Station, and the city’s well-known North End. The main issue being the disconnect during the transition period of healing, it is important that the patients are located in an area that is easy to adapt to while not being too overwhelming. The city of Boston has a variety of neighborhoods that allow diversity in scale and setting. This particular area has the accessibility to everyday needs like public transportation, residential facilities, and commercial buildings for different uses. This location also includes a level of open space for open opportunity. This makes the possibilities for access to natural elements somewhat easier to achieve.
Figure 67.
An aerial view of proposed site: Boston, MA and the program that surrounds it.
• • • •
Sandwich Shop Hair Salon Restaurant Apartment Homes
• Boston Common Coffee Co. • Landmark News • Apartment Homes • Citizens Bank • CVS Pharmacy • • • • •
CBT Architects Legal Services UMass Lowell Innovation Brew Pub Boston Sports Bar
• Apartment Homes • • • • •
Social Services Print Shop Non-profit Education Language School Nail Salon
• • • •
Restaurants Bakery Non-profit Disabilities Financial Planner
• Insurance Agency
• Hotel • Employment Agency
88
• Condominium Complex • Software Company
Chapter 3 | Design As Research
• Haymarket Station
Transitional Sequence
Transitional Joint
Transitional Overlap
Program Impacting Site
Openness to Site
IL
TA
RE
Opportunity for Community
L
IA
T EN
D
SI
RE
IL
A ET
R
N
TIO
TA
OR
SP
AN
TR
Figure 68.
Analytique iteration representing different factors of healing while including site context at different scales.
This issue of transition from recovery to reality is one that is currently impacting the relapse rates of alcoholism. With that, the healing environment in which people are being treated, must entail all components that will benefit the quality of life within their time inhabiting the space. The aspects include the inclusion of natural elements like light and landscape, as well as the optimal amount of integration with its surroundings. Presently, facilities with this function are often isolated, leading them into an even stronger disconnect back into society. It is important to incorporate community program to help progress patients back into their everyday life. Part of this healing process involves the “Twelve Steps� that are most frequently referred to as an essential piece to recovery. Site Selection
89
Community within itself
Optimal Access to Natural Elements
Integration with Community
Access to Prog
CONS
PROS
No Distractions
Rural
Urban
90
Chapter 3 | Design As Research
Distant from Society
No Reminder of “Everyday Life”
Figures 69 & 70.
Diagramming over a rural setting and an urban setting; comparing specific elements. Figure 71.
A figure comparing the pros and cons of each setting deter-
o Everyday gram
mining the benefits and challenges of both.
“Reality”
“Retreat”
Too many Distractions
Too Overwhelming
Not Enough Access to Natural Elements Site Selection
91
June 21 10:00 am
June 21 4:00 pm
Dec 21 10:00 am
Dec 21 4:00 pm
Figures 72, 73, 74 & 75.
A sun analysis done on site to determine how much
accessible light there is for
possibility of light and landscape integration.
92
Chapter 3 | Design As Research
Figure 76.
A diagram looking at the amount of open space around Boston and trying to expand on it.
Figure 77.
Access to transportation is
essential to not only an urban
MBTA Stop Train Route Bus Route
setting but anywhere for people coming out of or entering recovery.
Figure 78.
Looking at relatable program around Boston to bring into
Hospital Library Community Center
facility.
Site Selection
93
Programmatic Relationships
The recovery process for alcoholism is one that is a
When it comes down to determining program ele-
lifelong commitment. In order to fully succeed this
ments for this type of rehabilitation center, these
type of healing anywhere, one must understand the
“steps” were narrowed down to three major ideas:
“Twelve Step Process” that the group of Alcoholics
Acceptance, Spirituality, and Moving Forward. From
Anonymous has created. This type of revival back to
these ideas, program relationships then started to
physical and mental health is not a straight line by
form. After closely analyzing the many iterations of
any means. These “steps” all work off of each other
configurations, it was evident that these spaces could
and are reliant on one another in a program sense.
indeed become flexible rather than stationary. Each
There is no direct path to recovery. Therefore, mul-
program deserves a high quality level of design and
tiple journeys have to be considered in the design
attention. Each one should be recognized as space
process of this center. There also must always be a
for both the individual and a group setting when
clear consideration of the urban fabric when design
needed. These elements are essential to maintain,
every “moment” as shown above.
because no recovery process is the same.
Figure 79.
A diagram representing the “Twelve Step Process” and how these terms could be translated architecturally.
94
Chapter 3 | Design As Research
Figures 80, 81 & 82.
A series of sectional diagrams
beginning to analyze program-
Group Meetings Community
matic relationships that connect Community
Individual Meetings
Patient Rooms
Community
Group Meetings
to the recovery process.
Patient Rooms Community Individual Meetings
Group Meetings Community
Individual Meetings
Patient Rooms
Community
Group Meetings Community
Patient Rooms Community Individual Meetings
Community
Individual Meetings
Group Meetings
Community
Patient Rooms
Individual Meetings
Community
Individual Meetings
Group Meetings
Community
Patient Rooms
Individual Meetings
Community
Individual Meetings
Group Meetings Group Meetings
Individual Meetings
Community Group Meetings
Community
Individual Meetings
Community Group Meetings
Community
Individual Meetings
Patient Rooms Community Community
Patient Rooms
Individual Meetings
Community
Individual Meetings
Group Meetings Group Meetings
Community
Community Group Meetings
Community
Individual Meetings
Patient Rooms Community Community
Patient Rooms
Individual Meetings
Community Group Meetings
Programmatic Reltationships
95
The Transition Figure 83.
A diagram that begins to balance the missing pieces between programmatic elements.
When thinking about the period between exiting a recovery center and entering a home, we often lose track of the process that was worked so hard for. It is important to maintain the lifestlye that has healed you in order to continue the path of never-ending recovery. The balance between programmatic elements must be equal in order to achieve a successful rate of people staying sober even after rehab.
96
Chapter 3 | Design As Research
Figure 84.
This discursive image shows an integrated approach to
placing program into an urban setting, defeating the idea of complete isolation.
The reason why transitioning back to real life can be so hard is because of the isolation factor. Most treatment centers are completely separated from urban areas in order to allow patients to focus as well as keeping them away from any possible temptations. In a city setting, it can be hard to concentrate on healing when there are so many other elements that are distracting. However, by starting to implement healing environments, the city itself can hopefully become more accepting.
The Transition
97
Members of the Panel
Meliti Dekeos
Assistant Professor | Wentworth Institute of Technology
Luis Flores
Adjunct Professor | Wentworth Institute of Technology
Jer Jurma
CO-OP + CAREER Advisor | Wentworth Institute of Technology
Lora Kim
Associate Professor | Wentworth Institute of Technology
Kevin Lee
Designer | Sasaki
Michael Wolfson
Independent Thesis Advisor Adjunct Professor | Wentworth Institute of Technology Principal | Meandor Studios
Figure 85.
Photo taken on 3.5.20 during the final Design Test Review
(last in-person review due to Covid-19) before the Penultimate which occurred via Zoom in the following weeks.
98
Chapter 3 | Design As Research
Design Test Review
The Transition
99
Figure 86.
An early on abstract model representing the relationship between space and how possible thresh-
100 Chapter 3 | Design As Research
olds within could be formed.
Figure 87.
A preliminary perspective view
into one of the voided courtyards that begins to shape the space around it.
Figure 88.
A sectional perspective looking at the intervention as a whole
and determining what the program exactly is and how peo-
ple interact within it as well as around it.
The Transition101
Figure 89.
Figure 90.
102 Chapter 3 | Design As Research
Figure 91.
Figure 92.
Another sectional view on how program works together while
including people of the community as well as patients. Figures 93 & 94.
A prelimanary model as well as a more detailed one, showing how real program is starting to be
formed from the orginial form that was envisioned as abstractly.
The Transition103
Analytique: Transition
Recovery Process
Light & Landscape
Community
Access
Building
Neighborhood
City
Anywhere
100
50
0
Receive Care
Relapse
Patients
Bibliography Al-Anon Family Al-Anon. Paths to Recovery: Al-Anon’s Steps, Traditions, and Concepts. Al-Anon Family Groups, 1997.
“History of Rehab Facilities.” Dual Diagnosis, Dec. 2014, dualdiagnosis.org/drug-addiction/history-rehab-facilities/.
Kantrowitz, Min. Design Evaluation of Six Primary Care Facilities for the Purpose of Informing Future Design Decisions. Center for Health Design, 1993.
106 Chapter 3 | Design As Research
Image Sources *Unless cited below, all images offered in this book were created by author, Cristen Mabardy.
Figure 30:
New York State Inebriate Asylum. National Historic Landmarks Program. 2014.
Figure 32:
Kantrowitz, Min. Design Evaluations of Six Primary Care Facilities. 1993.
Figure 39:
Hart, Rob’t. Rehabilitation Centre Groot Klimmendaal. April 2011.
Figure 48:
de Rijke, Alex. Maggie’s Oldham. July 2017.
Figure 31:
Macek, Katy. Leader-Telegram. 2018
Figure 37:
Gates, Chris. Green Mountain Treatment Center. 2016
Figure 40:
Jeskova, Justa. Audain Art Museum. 2019
Figure 49:
Seier. Carlo Scarpa, Architect: Biennale Sculpture Garden, Giadino Delle Sculpture,
Figure 64:
de Rijke, Alex. Maggie’s Oldham. July 2017.
Figure 85:
Kim, Lora. Cristen Mabardy’s Design Test Review. March 2020. Wentworth Institute of
Figure 65:
Venice 1950-1952. Sept 2012.
Hart, Rob’t. Rehabilitation Centre Groot Klimmendaal. April 2011. Technology, Boston.
Accumulated Sources107
4
Outcomes Overall Proposal Methods of Design Transitional Thresholds
Boston, MA
Traffic: Weekend 12:00 pm
Urban Rehabilitation:
Individual Phases Open Space
The city of Boston has a variety of neighborhoods that allow diversity in both scale and setting. This particular area, centered near Haymarket, North Station, and the city’s well-known North End, has the accessibility to everyday needs like public transportation, residential facilities, and commercial buildings for different uses. This location also includes a level of open space for open opportunity. The possibilities for access to natural elements are somewhat easier to achieve. The main issue being the disconnect during the transition period of healing, it is important that the patients are located in an area that is easy to adapt to while not being too overwhelming. to adapt to while not being too overwhelming.
Creating Spaces to Heal and Transition to E
Recovering Transitioning Community
By incorporating community and urban factors into a healing setting, the tion from recovery to the daily life of an individual is possible. This, overal benefit the lifelong commitment alcoholics have with becoming and stayin sober. Maggie’s Center: Oldham, England
Void Pedestrian Street Pedestrian Street Pedestrian Building Access Access Access Connection Envelope (Landscape)
Urban Scale
Pedestrian Access
There is a strong disconnect during the period between recovery and retu to everyday life. This thesis develops a rehabilitation center that offers a s of thresholds: one at the urban scale that defeats the idea of isolated hea the next at an architectural scale that incorporates program that relates to the patient and the community. These transitional thresholds restore life b into recovery, making the healing transformation practical. In order to ens proper rehabilitation, there must be a sense of acknowledgement with bo components that are meant to heal as well as the urban environment.
Urban Scale
Visual Connection
Traffic: Weekday 5:00 pm
MBTA Routes & Stops MBTA Stop Train Route Bus Route
Groot Klimmendaal Rehabilitation Center
Street
Building Envelope
Pedestrian Access
Sun Studies
Void Connection (Light)
Visual Connection
Void Connection (Landscape)
Visual Connection
Street Pedestrian Access
Urban Scale
Biennale Pavilion: Carlo Scarpa
Nearby Relatable Program Hospital Library Community Center
Dec 21 10:00 am
Dec 21 4:00 pm
Urban Scale
Pedestrian Access
Visual Connection
Pedestrian Access
Audain Art Museum: Patkau
June 21 10:00 am
Void Visual Connection Connection (Light)
Void Street Building Envelope Connection (Light)
Pedestrian Access
Street
Pedestrian Access
• Community
• Light
• Saftey
• Landscape
• Definite Programmatic Spaces
• Safety
• Reliance on Others
• “Home”
• Efficiency
• Comfort
• Equity
• Simple Palet
• Appropriate Individual Spaces
• Silence
Urban Scale
June 21 4:00 pm
2
1
3
• Sandwich Shop • Hair Salon • Restaurant • Apartment Homes • Boston Common Coffee Co. • Landmark News • Apartment Homes • Citizens Bank • CVS Pharmacy • • • • •
CBT Architects Legal Services UMass Lowell Innovation Brew Pub Boston Sports Bar
• Apartment Homes • • • • •
Social Services Print Shop Non-profit Education Language School Nail Salon
• Restaurants • Bakery • Non-profit Disabilities • Financial Planner
3 • Insurance Agency
• Hotel • Employment Agency
• Condominium Complex • Software Company
1
• Haymarket Station
Programmatic Relationships
2
Section A 0 2
8
16
Group Meetings Community
Community
Individual Meetings
Patient Rooms
Community
Group Meetings
Patient Rooms Community Individual Meetings
Small community groups begin to form.
First form of rehabilitation in U.S. Group Meetings
Dr. Keeley creates “secret formula” to try and cure alcoholism.
New York State Inebriate opens;
Charles B. Towns Hospital opens where treatment was $350/day.
Prohibition; Failed attempt at limiting alcohol.
Community
Individual Meetings
Patient Rooms
Community
Group Meetings Community
Patient Rooms Community
1750
1785
1850
1840
1864
1867
1879
1890
1901
1919
1920
1
Individual Meetings
Rural
Semi-Urban
Kendall Square, MA
Urban
Chicago, IL
“Sober houses” created by Founding Father, Benjamin Rush.
Lodging homes open; First Inebriate home opens in Boston, MA.
History of Alcoholism in the U.S.
Figure 95.
A final compilation of what the final presentation would have looked like, had Covid-19 not affected in-person classes.
110 Chapter 4 | Outcomes
The Martha Washington Home in Chicago, IL becomes first rehab for alcoholic women in U.S.
Inebriate homes close and alcoholics are sent to drunk tanks, wards, and insane asylums.
Morphine maintenance clinics are created to treat people with morphine addictions.
Narcotics farm vides free trea and a
Cristen Mabardy
Building Thresholds
Transitional Process
Urban Thresholds
Everyday Life
transill, will ng
Concern Disconnected Denial
Adjust Accept Renew
Fantasy
urning series aling; o both back sure a oth the
Adapting
During vs. After Care
DURING
Withdrawing 100
Too Comfortable Old Habits Fall Back
50
0
Receive Care
AFTER
Section A
Reality New Beginning Excitement Risk
West Elevation
Relapse
South Elevation
Causeway St.
Valenti Way
New Chardon St.
Section B
Sudbury St.
Hanover St.
Patients
• Adaptability • Familiarize • Flexible Programmatic Spaces • “Life” Spaces • Reflection
tte
• Routine • Support
Transition
Section C
4
Recovery Process
6
5
Light & Landscape
6
21. Inpatient A Care (Double Rooms) 22. Inpatient B Care (Single Rooms) 23. Accepting Terrace 24. Reaching Out Terrace
17. Self Inventory Therapy 18. Group Session Therapy 19. Mending Rec Center 20. Support Terrace
13. Educational Group Study 14. Individual Study 15. Connecting Terrace 16. Meditation Rooms
Level 5 0 2
8
16
Level 4 0 2
8
16
Level 3 0 2
8
16
5 4
Community
0 2
8
16
Community
Individual Meetings
Group Meetings
Community
Bill Wilson and Dr. Bob Smith find Alcoholics Anonymous; 12 steps est.
1935
m opens and proatment to addicts alcoholics.
1935
AA memberships surpasses 90,000.
1945
1955
1956
1960 1958
1964
Mental Health Parity and Addiction Equity Act is passed that requires insurance companies to provide similar benefits for mental health and/or substance use treatment.
Secular Organizations for Sobriety and Rational Recovery are founded to emphasize rational decision-making, not spirituality.
Insurance industry begins to reimburse treatment of alcoholism.
Halfway House Association is founded.
1975
1985
1994
Community
2008
American Medical Association declared Alcoholism as an illness.
National Institute of Mental Health establishes National Center for Prevention and Control of Alcoholism.
Government decentralizes substance abuse rehab and turns decisions over to states.
SMART Recovery is founded; A non-12-step program focused on self-empowerment thatteaches skills of self change, helps people cope and manage thoughts, feelings, etc.
Individual Meetings
Group Meetings
Community
National Committee for Education on Alcoholism launched by Marty Mann, the first woman to complete 12 steps.
Patient Rooms
Individual Meetings
Patient Rooms
Individual Meetings
8. Library 9. Quiet Reading Room 10. Front Terrace 11. Back Terrace 12. Growth Terrace
Section C
Programmatic Relationships
Section B
0 2
8
Level 2 0 2
8
16
16
Community
Individual Meetings
Community Group Meetings
Community
Individual Meetings
Community
Access
Group Meetings
Void Connections
1. Seed Planting 2. Produce Distribution 3. Leisure Garden 4. Community Cafe 5. Grab ‘N Go 6. Admittance to Recovery 7. Cooking Classes/Preparation
Overall Proposal 111
Ground Level 0 2
8
16
Members of the Panel
Ben Hait
Adjunct Professor | Wentworth Institute of Technology Adjunct Professor | Northeastern University
Kelly Hutzell
Director of the Graduate Program; Department of Architecture | Wentworth Institute of Technology Associate Professor | Wentworth Institute of Technology
Lora Kim
Associate Professor | Wentworth Institute of Technology
Sam Maddox
Adjunct Professor | Wentworth Institute of Technology Adjunct Professor | Boston Architectural College
Karen Nelson
Dean & Faculty of the School of Architecture | Boston Architectural College
Durga Suresh
Special Assistant to the Provost of Graduate Programs | Wentworth Institute of Technology
Michael Wolfson
Independent Thesis Advisor Adjunct Professor | Wentworth Institute of Technology Principal | Meandor Studios
112 Chapter 4 | Outcomes
Final Thesis Defense
Figure 96.
An iteration involving the formation of space created by voids.
Overall Proposal 113
Overall Proposal The overall proposal of this thesis investigation was a rehabilitation center for people recovering from the disease of alcoholism while being integrated into the urban community. The scene is set in Boston, MA in order to challenge the factors of the urban context that many similar facilities often try to shy away from. The aspects involved in this design intervention have a relation to both the necessities of a healing environment as well as elements brought in by the surrounding community. Throughout the recovery process of alcohol addiction, it is essential for patients to feel connected to one another on some level, while also having access to individuality as every healing process differs. In order to keep these factors in mind, the design intent of this center was always being able to connect people. This is where the urban community comes in, as well as having a sense of community within itself. The method of design in which this building was produced, was discovering a series of voids that then led to the connection between program. Moving up and through the facility, voids are created and overlaid to shape a space. These spaces are both physically and visually meant to read as a reminder of the space someone is in. In order to have a successful recovery in a city setting, the surroundings must not be downplayed. Certain elements of light, landscape, materiality, and blurred lines between the interior and exterior are portrayed in different ways to maintain the essence of a healing space while being incorporated in the city. Figure 97.
An abstract take on the relationship between the healing environment and its urban surroundings.
114 Chapter 4 | Outcomes
Overall Proposal 115
Figure 98.
Perspective view of approaching intervention towards Hay-
market. Notice community members interacting with patients through connection voids being formed at the ground level.
Figure 99.
Interior view of community cafe. A double-heighted space
allows for ultimate communication between program and a more welcoming space.
116 Chapter 4 | Outcomes
1
7
2
3
6
5
4
1. Seed Planting 2. Produce Distribution 3. Leisure Garden 4. Community Cafe 5. Grab ‘N Go 6. Admittance to Recovery 7. Cooking Classes/Preparation
Ground Level Overall Proposal 117
Figure 100.
A view taken from the back terrace looking toward the front entrance. This perspective experiences the void in which
light passes through the building all the way to the top level.
Figure 101.
Another experience from outside passing by the courtyard
and looking toward the interior. Here is when one really notic-
es the blurred line between interior and exterior.
118 Chapter 4 | Outcomes
11
12 10
9
8
8. Library 9. Quiet Reading Room 10. Front Terrace 11. Back Terrace 12. Growth Terrace
Level 2 Overall Proposal 119
Figure 102.
A serene meditation room allowing for light to pass through while also maintaining some level of privacy.
Figure 103.
A look towards a threshold leading between spaces. How
materiality can play a role in transition as well as movement.
120 Chapter 4 | Outcomes
16 16
16
16
16
16 16
16
16 14
16 16
13
13. Educational Group Study 14. Individual Study 15. Connecting Terrace 16. Meditation Room
15
16
Level 3 Overall Proposal 121
Figure 104.
An example of visual connection back to the city. Taken from one of the many terraces, this view represents a relationship between an urban scaled and architectural scaled threshold.
Figure 105.
A look towards one of the courtyards where many programs come together. Here, one can see how the use of materiality can direct people in different ways.
122 Chapter 4 | Outcomes
19
20
18
17
17. Self Inventory Therapy 18. Group Session Therapy 19. Mending Rec Center 20. Support Terrace
17
17
17
17
17
17
Level 4 Overall Proposal 123
Figure 106.
The amount of privacy in recovery is just as important as
community. Here, it is shown how the facade works based on level of privacy a certain program needs.
Figure 107.
The quality of outdoor space is just as important as the interior. This view portrays a moment of pause while being able to look out into the city and always feel connected.
124 Chapter 4 | Outcomes
22
21
23
24
21. Inpatient A Care (Double Rooms) 22. Inpatient B Care (Single Rooms) 23. Accepting Terrace 24. Reaching Out Terrace
24
24
Level 5 Overall Proposal 125
Figure 108.
Figure 109.
Sectional perspective of
Front elevation looking at how
periencing the voids that are
with the building.
entirety of intervention excreated.
126 Chapter 4 | Outcomes
people of the community interact
Figures 110 & 111.
Zoomed in moments analyzing the relationship between the interior and exterior.
Overall Proposal 127
Figure 112.
Another sectional view
looking at the relationship between the building and across the street.
128 Chapter 4 | Outcomes
Figure 113.
A nighttime rendering of the right elevation representing how the
facade allows for not only light to come in, but light shining out.
Figures 114 & 115.
A view looking more closely at the
courtyard and how it plays a role in tying
program together. Another view studying the building’s envelope and how it could change for different spaces.
Overall Proposal 129
Figure 116.
Figure 117.
This section is also por-
This left elevation allows a full view
showing the multiple ways of
with the community greenhouse.
traying the voids, as well as accessing site.
130 Chapter 4 | Outcomes
of how people access and interact
Figures 118 & 119.
A couple more views taking a closer look at the facade system and specific mo-
ments where it alters based on program.
Overall Proposal 131
Methods of Design The method in which these drawings and overall design were produced was by a system of voids. Early on, a grid was created in order to begin to envision where spaces could be formed. This allowed for several iterations to be made overtime as well as always keeping structure in mind. While creating these voids, it was important to fill them with not definite program, but other elements that could connect the program around them. These elements happen to be light, landscape, materiality, and visual connection. These void connections also helped capture the significance of blurring the boundary between the inside and outside. Since this is an essential part to recovering in an urban setting, keeping the exterior as visible as possible is crucial. Another process of design taken place in this proposal was the idea of analyzing the journeys of three different people. Every program in this building is meant to be a space that includes everyone. Whether it’s a library, cafÊ, or meditation space, every person should have a space for themselves. For example, in the library, there is one large studying space for people who want to collaborate and be in a group setting. On the other hand, there is also a smaller, enclosed reading room for someone who may want to be alone and feel more sheltered while they read or study with less distractions. This system’s objective is to create areas that are beneficial for all types and speeds of recovery.
Figure 120.
An axon view of all the levels
overlaid, showing how the voids connect with one another, leav-
132 Chapter 4 | Outcomes
ing space for program inbetween.
Figure 121.
This diagram rep-
resents the phases of three different indi-
viduals: a recovering alcoholic, a transi-
tioning patient, and a member of the com-
munity. Each program created has different levels based on the
needs of the person. This is so everyone
has a distinct space for themselves, but all are able to interact and be interchanged.
Recovering Transitioning Community
Methods of Design 133
Transitional Thresholds While trying to connect program within the building
Figure 122.
A zoomed out site plan view, an-
is important, it is also essential to connect back to its
alyzing potential urban threshold
community. Looking at an urban scale instead of just
opportunities. This diagram is
a building scale, thresholds start to be determined.
based off of existing pathways and crosswalks around site.
Finding ways to encourage the user of the facility,
From there, they were then ex-
whether it’s a patient or member of the community,
tended through making it possi-
can be done through sectional and plan observa-
ble to create even more connec-
tion. Looking at how someone may access the site
tions to the urban fabric.
first and foremost is what might begin this series of thresholds. From there, looking at how visual connections can start to be made by gestures being produced in the building first, then feeding off of its surroundings. Moving into an architectural scale, thresholds can start to be seen more clearly. The following pages begin to diagram just how these moments of transition to the urban community form. These transitional thresholds happen at areas of the street level and how pedestrians’ access is created, at the void connections that were earlier analyzed in plan to create space for light, landscape and materiality to bring
Figure 123.
program together, and points of visual connection to
A sectional diagram through site
the urban scale.
comparing the built form and the
possible thresholds that could be
Causeway St.
Valenti Way
New Chardon St.
134 Chapter 4 | Outcomes
Sudbury St.
created sectionally.
Hanover St.
Transitional Thresholds 135
136 Chapter 4 | Outcomes
Transitional Thresholds 137
Street
Building Envelope
Figure 124.
Taking a main section, and determing possible thresholds that could be connected through the building and into the urban context.
138 Chapter 4 | Outcomes
Pedestrian Access
Void Connection (Light)
Visual Connection
Void n Connection (Landscape)
Visual Connection
Street Pedestrian Access
Urban Scale
Transitional Thresholds 139
Urban Scale
Void Pedestrian Street Pedestrian Street Pedestrian Building Access Access Access Connection Envelope (Landscape)
Figure 125.
A similar section where potential thresholds can start to be formed in relation to its surroundings.
140 Chapter 4 | Outcomes
Pe A
edestrian Access
Visual Connection
Urban Scale
Transitional Thresholds 141
Urban Scale
Figure 126.
Pedestrian Access
Thresholds beggining to form in a different sectional view including more pedestrian access to site.
142 Chapter 4 | Outcomes
Visual Connection
Pedestrian Access
Void Connection (Light)
Visual Connection
Void Street Building Envelope Connection (Light)
Pedestrian Access
Street
Pedestrian Access
Urban Scale
Transitional Thresholds 143
5
Critical Reflection To Be Continued Self-Evaluation
To Be Continued Given if there were just two more weeks, this thesis
Architecture comes in when determining the built
investigation could certainly be pushed even further.
space. Architecture is about people. Without it, what
This overall proposal has become more than what
even is society? Does it exist? While exploring how
was initially envisioned. Since the design process
the built environment can persuade healing, there are
was only refined within the last month or so, the level
more factors to consider than what was produced in
of research and work could progress even more.
this proposal. The amount of “everyday life” aspects
There could be more examination in many aspects
is infinite when considering the inclusion of every
that were left behind or underdeveloped. It is essen-
type of individual’s process of healing. This thesis is
tial to keep in mind that the overall exploration of this
possibly only the beginning of finding the answer to
thesis was meant to capture the essence of bettering
an increased success rate of overcoming alcoholism.
the life after recovery. Even though recovery is a lifelong commitment, people don’t stay put in one facility forever. Therefore, it is important throughout this thesis to continue to explore options to improve the life of recovering alcoholics. This thesis only began to do so. By placing this currently isolated typology within an urban fabric, it allowed for analysis on just one type of environment. However, there were many challenges that were overcome within this proposal. Moving forward, the objective behind this rehabilitation intervention is to reinstate the importance of alcoholism recovery. As previously mentioned, alcoholism isn’t often seen as a disease within society. However, it is in fact declared as an illness. It deserves the same amount of attention as any other sickness. To society, alcohol is a brand. It is something advertised in a positive light, allowing most to think of it as a choice rather than something that could potentially be life-threatening. With this thesis, the intent still lies in the hands of society. It is the responsibility of humanity to accept this illness as what it is, and to take away the stigma that controls the lives that are lost.
146 Chapter 5 | Critical Reflection
Figure 127.
An ad advertising the negative effects of alcohol, rather than what society is used to which is normally positive.
To Be Continued147
Self-Evaluation As anticipated, the reviewers had a lot to say during
ment was brought up. This is something that I hadn’t
the final thesis defense. Going into it, I set up a set
necessarily thought of initially, but when it was men-
of questions that I expected were to be asked of me.
tioned during the review, it made me think. It made
Though some of those were addressed, others were
me think more about how someone moves through
things I hadn’t yet thought of. Across the board, and
life and not just the space they are in. Movement in
as one of the elements I knew needed to be further
recovery is crucial, because recovery is a lifelong
developed, was the more detailed inclusion of the
journey. It doesn’t stop. Therefore, moving forward,
urban environment. In most of my proposed work,
analyzing certain delayed moments that most likely
the city was there, it just wasn’t as apparent as it
will happen during one’s journey of healing, would
could have and definitely should have been. This is
raise some discoveries and wonder.
something I was aware of when finalizing my design and putting the last details in. Had I had more time
The overall consensus of the panel was to bring all
towards the end, I would have put more thought into
these thoughts together and push it just a little fur-
the urban fabric and drawn out what these connec-
ther. It was mentioned how the level of work done
tions actually were. Since this is a vital element of
was able to provoke more detailed considerations.
this thesis, it is important to expand on what these
There was much appreciated praise that this topic
“visual connections” and “transitional thresholds” are
was being done and how developed it had gotten
throughout the project and not just within the built
within such a short period of time. Another battle,
space I came up with. Connection to the community
along with time, that this thesis investigation had to
is essential, so magnifying this particular aspect
endure was the strive to completion due to Covid-19.
would have been greatly beneficial.
Even though the semester was cut short, in terms of face-to-face meetings, this project was still able to
Some more comments were made in terms of design-
have a developed enough scheme in order to defend
ing and how ideas could have been taken a step fur-
it. It was also said that my thought process was
ther. These spaces of transition were seen all over as
clear from start to finish and how the final work really
a whole, but they weren’t yet defined. For example,
spoke to the initial ideas I had during this investiga-
the screening element I had on the façade where it
tion. Since the final thesis defense was presented
varied based on where program was placed in terms
via Zoom due to Covid-19, I was unable to present
of privacy, was everywhere. A suggestion of making
in the conventional way of “pinning up” and walking
this component special and only identifying it in some
the critics through my process. However, I think this
specific areas rather than all over was made. This
format of presenting a slideshow worked in my favor.
would then make the use of materiality as a thresh-
My narrative was easier to understand and overall
old even more judicious. As far as moving through
guided the panel through my thesis proposal in a
spaces goes, the thought of spatially delaying move-
clear and concise manner.
148 Chapter 5 | Critical Reflection
Finally, what I’d hope for this thesis to be is everything and more. It is something I’ve worked tirelessly for during this past year. It is something that was inspired by my mother, and losing her to this awful disease of alcoholism. In a way, it is something I’ve been preparing for and investigating my whole life. My goal for this thesis is to take away the stigma of alcoholism, leaving room for people having higher success rates of fulling healing. Society needs to accept it as the illness it is. What better way to do so than to put a rehabilitation right in the center of it? Integrating community into recovery is essential. No one can recover alone. Figure 128.
A photo of an AA meeting in progress, representing just how important group settings are for recovery.
Self-Evaluation149
150 Chapter 5 | Critical Reflection
Image Sources *Unless cited below, all images offered in this book were created by author, Cristen Mabardy.
Figure 127: Figure 128:
Sison, Gerardo. Long-Term Effects of Alcohol Abuse. Addiction Campuses. 2019 Van Hasselt, John. An Alcoholics Anonymous meeting. Los Angeles Times. 2020
Accumulated Sources151
Urban Rehabilitation
Cristen Mabardy M.Arch 2020