THE ARCHITECTURE OF LIGHT; HEALING PROCESSES AND PSYCHOLOGICAL OUTLOOKS
IONA HAIG 1
the architecture of light
FRONT PAGE IMAGE: NEWCASTLE MAGGIE’S CENTRE ROOF DETAIL (AUTHORS OWN IMAGE) BACK PAGE QUOTE: AS SEEN IN RUSKIN, J. (1981) THE STONES OF VENICE. BOSTON, MA: LITTLE BROWN AND COMPANY. A DISSERTATON SUBMITED IN PARTAL FULFLMENT OF THE BA ARCHITECTURE HONOURS DEGREE, NEWCASTLE UNIVERSITY, 2016. COPYRIGHT © IONA FRANCES HAIG, 2016.
2
3
IONA HAIG 30151298 the architecture of light
DISSERTATION (8,968 WORDS)
4
ARCHITECTURE BA HONS 2016 NEWCASTLE UNIVERSITY
THE ARCHITECTURE OF LIGHT; HEALING PROCESSES AND PSYCHOLOGICAL OUTLOOKS
5
“ BEAUTY HAS A
HEALING
POWER
”
-CLAUDE MONET 1
ABSTRACT The potential daylight has to heal and nurture has inspired this dissertation to study light and the potential windows possess in radically changing the design of healthcare environments. This work aims to gather evidence to demonstrate that light is a positive environmental factor in healthcare the architecture of light
architecture, and analyse the ways modern healthcare designs such as the Maggie’s Cancer Care Centres use light to achieve uplifting environments for patients and visitors, amongst other positive environmental factors. The potential for a health focused approach to architecture is an exciting and groundbreaking approach as it has the possibility to merge the boundaries between the architecture and medical professions. This would create a unity of knowledge to contrive a coherent conversation between people and the spaces they inhabit.
1 Claude Monet in Purves, G. (2001) Healthy living Centres: A guide to primary health care design. Oxford: Architectural Press, p. xiii.
6
7
CONTENTS LIST OF FIGURES ....................................................................................................10 ACKNOWLEDGEMENTS ........................................................................................12 CHAPTER 1.1 1.2 1.3 1.4
1: INTRODUCTION ................................................................................14 Introduction Aims Research Questions Framework
the architecture of light
CHAPTER 2: LIGHT .................................................................................................16 2.1 Introduction 2.2 Evidence for the positive effect light has on healing processes 2.3 Evidence for the positive effect of light on mood 2.4 How are healing and mood improved by light? 2.5 Evidence that positive emotions can improve health and healing 2.6 Conclusion CHAPTER 3: WINDOWS .........................................................................................28 3.1 Introduction 3.2 Factors hat aid healing other than light provided by windows 3.3 How much light do we need? 3.4 Evidence Based Design 3.5 Conclusion CHAPTER 4: METHODOLOGY ..............................................................................40 4.1 Methodology 4.2 Interview with Karen Verrill CHAPTER 5: MAGGIE’S CENTRE .........................................................................44 5.1 Maggie’s Centres 5.2 Comparing use of light in the three Centres 5.3 Newcastle Maggie’s Centre by Ted Cullinan Studios 5.4 Dundee Maggie’s Centre by Frank Gehry 5.5 Edinburgh Maggie’s Centre by Richard Murphy 5.6 Conclusion CHAPTER 6: CONCLUSION ..................................................................................58 APPENDIX ...............................................................................................................62
8
BIBLIOGRAPHY ......................................................................................................72
9
LIST OF FIGURES FIGURE 1: Interpretation of Geoffrey Purves diagram in ‘Healthy Living Cen-
FIGURE 14: Entrance/ waiting area, Golden Jubilee Hospital Vancouver.
FIGURE 2: Impression of Acropolis, Ancient Greece by Leo Von Klenze.
FIGURE 15: Newcastle Maggies Centre by Cullinan Studio.
(Source:https://upload.wikimedia.org/wikipedia/commons/c/c4/Akropolis_by_Leo_ von_Klenze.jpg)
(Source: http://cdn.wallpaper.com/main/legacy/gallery/17053959/01_Maggies_Newcastle.jpg)
FIGURE 3: Alvar Aalto’s TB Sanatorium, Finland.
FIGURE 16: Dundee Maggies Centre by Frank Gehry.
(Source: http://paimiosanatorium.fi/)
(Source: https://qingliu67.files.wordpress.com/2011/09/img_38332.jpg)
FIGURE 4: Sun balcony at Alvar Aalto’s TB Sanatorium, Finland.
FIGURE 17: Edinburgh Maggies Centre by Richard Murphy Architects.
tres’ (Source: Purves, G. (2001) Healthy living Centres: A guide to primary health care design. Oxford: Architectural Press.)
(Source: http://paimiosanatorium.fi/)
the architecture of light
FIGURE 5: Alvar Aalto: Early cantilevered armchair with stepped base, model
(Source: http://www.jcfgroup.ca/projects/view/2421/Royal_Jubilee_Hospital_Patient_ Care_Centre)
(Source: http://static.wixstatic.com/media/174c3f_0f5d299a4c2971081e5c801ba1587087.jpg_1024)
no. 31, designed for the Tuberculosis Sanatorium, Paimio, 1929-1933. (Source: http://www.archdaily.com/500442/on-auction-100-design-relics-from-niemeyer-lecorbusier-flw-and-more/535aa1e3c07a8072f2000007-on-auction-100-design-relicsfrom-niemeyer-le-corbusier-flw-and-more-image)
FIGURE 18: Section of Newcastle Maggies Centre by Cullinan Studio showing
FIGURE 6: Plan of the second floor of the study hospital showing the trees ver-
(Source: http://image.digitalinsightresearch.in/uploads/imagelibrary/Main/Maggie-Keswick-Jencks.jpg)
sus wall window views of patients. (Source:http://www.majorhospitalfoundation.org/pdfs/View%20Through%20a%20 Window.pdf)
FIGURE 7: Diagram showing PPA activity.
the importance of the sun. (Source: http://www.cullinanstudio.com/uploads/projects/Maggies_inline1.png)
FIGURE 19: Maggie Keswick Jencks in her garden in Portrack, Scotland.
FIGURE 20: Double height library space in Newcastle Centre.
(Source: http://retaildesignblog.net/2013/11/20/maggies-cancer-caring-centre-by-cullinan-studio-speirs-major-newcastle/)
(Source: Rajimehr, R. (2011). The “Parahippocampal Place Area” Responds Preferentially to High Spatial Frequencies in Humans and Monkeys. PLoS Biology, 9(4), p.e1000608.)
FIGURE 21: Library space from above in Newcastle Centre.
FIGURE 8: Example of a scene of increasing colour, depth and movement.
FIGURE 22: Images showing light quality. (Source: Authors own.)
(Source: http://aluclad.yolasite.com/resources/WindowView.jpg)
FIGURE 9: William Atkinson’s Shadow Diagram.
(Source: Hobday, R. (2006). The Light Revolution. Forres: Findhorn, p.82.)
FIGURE 10: William Atkinson’s Shadow Curves.
(Source: Hobday, R. (2006). The Light Revolution. Forres: Findhorn, p.83.)
(Source: http://www.archdaily.com/415127/maggie-s-newcastle-cullinan-studio/)
FIGURE 23: Plan by Ted Cullinan Studios.
(Source: http://cullinanstudio.blogspot.co.uk/2010_07_01_archive.html)
FIGURE 24: Kitchen, garden and counselling rooms. (Source: Authors own.) FIGURE 25: South facing tower in Dundee Maggies Centre.
(Source: http://www.e-architect.co.uk/architects/frank-gehry-architect)
FIGURE 11: An example of daylighting using electrochromic glass and a mir-
rored louver system. (Source: http://www.glumac.com/Q1%202013/Daylighting%20Glare%20Control.jpg)
FIGURE 26: Kitchen, sitting room and stair case in Maggie’s Dundee.
FIGURE 12: Different window to wall ratios and the resulting illumination.
FIGURE 27: Sketch by Richard Murphy.
(Source:http://sustainabilityworkshop.autodesk.com/sites/default/files/styles/large/ public/core-page-inserted-images/window_wall_ratio_-_revised.jpg)
FIGURE 13: Private en-suite hospital room, Golden Jubilee Hospital Vancouver. (Source: http://www.hhangus.com/royal-jubilee-hospital-patient-care-centreachieves-leed-gold/)
10
(Source: Authors own.)
(Source: https://www.maggiescentres.org/media/uploads/edinburgh-sketch.png)
FIGURE 28: Photos of Edinburgh Maggie’s Centre. (Source: Authors own.) FIGURE 29: Planned extension: proposal of a garden house.
(Source: Authors own photo of drawing displayed in Edinburgh Maggie’s Centre.)
11
ACKNOWLEDGEMENTS I would like to thank my tutor Dr. Neveen Hamza, for all her support and advice throughout the process of researching and writing this dissertation, and inspiring me to look further afield in my line of enquiry. I would also the architecture of light
like to give a special thank you to Karen Verrill at the Newcastle Maggie’s
12
Centre for allowing me to spend time in the centre, and being most welcoming and excited about this piece of work, as well as all the kind staff of the Dundee and Edinburgh centres who warmly welcomed me in the centres. My interest in this topic is a credit to Maggie Keswick Jencks, who through her inspiration and work has influenced me to see a world of architecture and design through new eyes, and appreciate the opportunity architecture has to make people feel and heal.
13
1
INTRODUCTION 1.1. INTRODUCTION
After nearly 500 years as the world’s greatest super force, the Roman Empire collapsed in 476 AD as a result of under developed socio-economic policies amongst other crippling factors. Modern day society is assumed to be more sophisticated than that of Ancient Rome with social welfare and human rights at the forefront of the majority of contemporary policies. However ancient Roman law protected citizens’ access to light to a similar degree as laws today, with current laws only protecting light access if it has the architecture of light
been ‘continued during 25 years’ with the only real light being ‘to the reception of light in a lateral direction’.1 Historian Paul de Plessis recognises that ‘the very existence of the concept of a right to a view reflects great credit on Roman law, which on occasion could attain sophisticated levels of development, even by modern standards.’2 Perhaps the lack of advancement of the right to light law is due to modern alternatives such as electricity and heating systems allowing the bypass of natural powers such as light and nature, whilst lack of scientific knowledge encouraged our predecessors to approach healthcare holistically. If greater importance was dedicated towards natural light and health orientated design, could the costs and burden on the National Health Service FIGURE 1: Diagram based on Geoffrey Purves’ diagram in ‘Healthy Living Centres’ showing the need for a relationship between the architecture and medical professions to create quality healthcare environments.
(NHS) be reduced? Therefore should architects and planners hold as much responsibility as doctors when it comes to our health and happiness? From ancient times light has been used as medicine- an ancient Egyptian medical text ‘Ebers Papyrus’ dating back to 1550 BC even recommends exposure to the sun.3 Perhaps one of history’s best-known nurses Florence 1 Gale, C. J. (1986) Gale on the Law of Easements 15th Edition. London: Sweet & Maxwell p. 260. 2 Plessis, P. J. (2010) Borkowski’s textbook on Roman Law. 4th Edition. New York: Oxford University Press, p. 163. 3 Hobday, R. (2006) The Light Revolution: Health Architecture and the Sun. UK: Findhorn Press, p.6.
14
15
Nightingale, once said ‘direct sunlight, not only daylight, is necessary for a 4
speedy recovery’.
It is important when discussing light to distinguish
the different forms of light, as extolled by Florence Nightingale. Direct
health care design and architecture. This will be done by looking to three of the Maggie’s cancer care centres as examples of healthcare design in which the provision of light is a notable architectural feature.
sunlight is the solar radiation that reaches the earth in parallel rays, and must be distinguished from daylight, which is a combination of sunlight and skylight- skylight being ‘solar radiation that is scattered in the atmosphere
1.3. RESEARCH QUESTIONS
5
before reaching the earth’s surface’.
- In what ways does light have a positive effect on healing processes and Professor of Architecture for the Healthcare Building Research Centre in
mood, and how does this relationship work? (Chapter 2)
Sweden, Roger Ulrich has pioneered studies into healing environments.
- What other factors provided by windows aid healing and what
His research has defined multiple environmental characteristics that can
specifications should be acknowledged to achieve maximum health potential
improve healing environments for patients and consequently improving
from windows? (Chapter 3)
general wellbeing, which Ulrich refers to as ‘positive distractions’.
- What is Evidence Based Design and how can it affect the way healthcare
These positive distractions are elements such as nature, natural light,
environments are designed? (Chapter 3)
6
materiality and autonomy of space, highlighted as design aspects of an
- Looking specifically at the Newcastle, Dundee and Edinburgh centres
environment that can target and reduce stress in patients. Studies have
how do the Maggie’s Centres incorporate light adding to their success as
demonstrated how patients have heightened stress levels in conjunction
environments of support and healing? (Chapter 5)
with ill health, and how alternately stress can have a corrosive effect on
the architecture of light
the healing process.7 Natural light, nature and autonomy of space were key environmental elements incorporated in the Maggie’s Centres design
1.4. FRAMEWORK
briefs and are evident features in the three centres this work analyses. The spectrum of architects who have designed the centres allow for them to
Chapter 1 outlines the core themes that are covered in this work, the aims of
become exemplars of the various interpretations of light in architecture
the dissertation and the research questions that will be asked.
from some of the world’s top architects. The centres create a new form of architecture that blurs the boundaries between the classical roles of
Chapter 2 examines the research that demonstrates the positive effect light
architect and doctor, which is believed to be a critical process for the future
has on healing processes and mood, and explains how this relationship
of healthcare design.
works. This chapter also questions whether there is a relationship between mood and healing.
1.2. AIM
Chapter 3 reviews the other factors provided by windows that aid healing, and examines how much light is needed to be beneficial and ways in which
This dissertation will examine the ways in which light can enhance a variety
it can be measured.
of healing processes and mood, how we can design for light provision, and review the importance of influencing a change in the world of modern day 4 Ibid, p.14. 5 Ibid, p. 26.
16
Chapter 4 explains the methodology that is used to study the Maggie’s Centres, and the interview process used to collect information with evidence supporting the success of the Maggie’s design from an interview with the
6 Ulrich, R. (1999) Effects of gardens on health outcomes. Chapter in C. Mar-cus and M. Barnes (Eds.), Healing Gardens: Therapeutic Benefits and Design Recommendations. New York: John Wiley, p. 49.
Newcastle Centre Head.
7 Schweitzer, Gilpin, and Frampton (2004) Healing Spaces: Elements of Environmental Design that Make an Impact on Health, Journal of Alternative and Complementary Medicine, Vol. 10. p. 49.
Chapter 5 introduces the Maggie’s Centres, looking into the Newcastle, Dundee and Edinburgh centres and comparing the use of light amongst
17
other architectural features in each. Chapter 6 concludes the research of this dissertation and questions whether there is a revolution for the way in which healthcare environments are designed.
‘One goes to a doctor to be cured of an ailment, and to an architect to get a good building. They both construct future worlds of better value. They are both prospective professions orientated to positive outcomes.’
the architecture of light
–Charles Jencks, co-founder of the Maggie’s Centres.8
8 Heathcote, E. and Jencks, C. (2010) The Architecture of Hope: Maggie’s Cancer Caring Centres. 1st Edition. London: Frances Lincoln Publishers, p.24.
18
19
2
RESEARCH INTO LIGHT AND HEALING 2.1. INTRODUCTION
The idea that light is important to healing and mental health has been prevalent for centuries, from Ancient Greece where temples dedicated to Asclepius the Greek god of healing were built high on hilltops overlooking the sea, orientated to receive optimum light throughout the day and give expansive views. Le Corbusier said of the Parthenon (shown in Figure 1): ‘those who have seen the Parthenon have felt that here was a decisive moment in the architecture of light
Architecture.’
9
During the nineteenth century, hospitals were designed with a focus on large openings to provide as much light as possible, partly to provide light before electricity was available but also to help patients recover. Le Corbusier’s design for the Venice hospital in the late 1900s ensured the provision of natural light, with all rooms receiving natural light ‘through glass walls...called ‘glass panels’’ as well as patients rooms gaining natural light from skylights above beds.10 Solariums were commonplace at the end of each ward in hospitals of the time- spaces that would be filled with natural light where patients could relax and be ‘restored by the benefits of direct daylight’.11 However, surprisingly little evidence based research was given towards the healing effects of light until the late twentieth century.
FIGURE 2: Impression of Acropolis, Ancient Greece by Leo Von Klenze.
Understanding in greater depth how and appreciating why responses to environment affect mood and wellbeing could give quality of environment equal importance as the quality of medical care in the NHS. The NHS 9 Corbusier, L. (1970) Towards a New Architecture. UK: Architectural Press, p. 222. 10 Shah, M. (2013) Le Corbusier’s Venice hospital project: An investigation into its structural formulation. Farnham, Surrey, England: Ashgate Publishing. p. 165 11 Sternberg, E. M. (2009) Healing Spaces: The Science of Place and Wellbeing. Cambridge, MA: Belknap Press, USA. p. 4.
20
21
Estates publication Environments for Quality Care shows the NHS’s changing
Being one of the first functionalist sanatoriums of it’s kind, it drew
attitudes towards holistic approach healthcare, and a turning point for
attention to the possibilities architecture could hold for health, considering
the appreciation of key environmental factors such as light in healthcare
every element of the design to suit patients from services to furniture.
design. Specific healthcare design could improve the efficiency of the NHS
Aalto designed the building to ensure maximum possible access to natural
alongside improving health standards throughout society. This chapter sets
light, positioning the sanatorium on a North-South axis. Figure 4 shows
out to acknowledge the variety of research that demonstrate the wide range
the South facing ‘sun balconies’ on the end of every floor and a large roof
of benefits light has on different healing processes, health and psychological
terrace to provide a space for patients to take in the expansive views and
outlook, and to underpin exactly how the important relationship between
fresh air.15
12
light and health works.
2.2. EVIDENCE FOR THE POSITIVE EFFECT OF LIGHT ON HEALING PROCESSES The Oxford English Dictionary defines healing as the ‘process of getting well, becoming sound or healthy again’.13 While this work looks to the Maggie’s Cancer Care Centres as case studies, the impact of light is far reaching and has an impact on a wide range of diseases and illnesses. This section will
the architecture of light
explore the research that evidences this. FIGURE 4: Sun balcony at Alvar Aalto’s TB Sanatorium, Finland.
TUBERCULOSIS Tuberculosis, otherwise known as TB, is a contagious disease that affects the lungs, caused by a bacterial infection.
14
Finnish Architect Alvar Aalto’s
FIGURE 5: Alvar Aalto: Early cantilevered armchair.
Patients responded positively to an environment focused to their needs, with even the chairs being designed at a slant to allow easy breathing
TB Sanatorium in Piamio (Figure 3), Finland aimed to create a focused
(Figure 5), and it is evident that the key focus on access to and provision
environment that would kick-start the healing process for TB patients.
of natural light was at the core of helping the patient’s healing process, whether inspiring recovery mentally or physically. Sunlight therapy was commonly used to treat Tuberculosis in the nineteenth and twentieth century, however it was not until 2005 that clinical trials were run to test the validity of the treatment. Science magazine published research in 2006 providing evidence for the claim that Vitamin D significantly aids TB immunity, with Vitamin D being gained as a result of exposure to UV rays.16 Sunlight therapy could be an important solution to healing and preventing TB, as the disease is capable of adapting to become drug resistant, as well as being a low cost treatment.
INTERNAL CANCERS FIGURE 3: Alvar Aalto’s TB Sanatorium, Finland. 12 Estates, N. (1994) Environments for quality care: Health buildings in the community. United Kingdom: Stationery Office Books. 13 Healing, Oxford Dictionary. Available at: http://www.oxforddictionairies.com/definition/english/ healing [Accessed: 10 December 2015] 14 Tuberculosis (TB) definitions (2012) Available at: http://www.niaid.nih.gov/topics/tuberculosis/ Understanding/WhatIsTB/Pages/TBdefinitions.aspx [Accessed: 24 November 2015]
22
Daylight has been shown to have an influence on internal cancers. The study ‘Night-shift work, sleep duration, daytime napping, and breast cancer risk’ 15 Piamio Sanatorium - Paimion Kaupunki (2013) Available at: http://www.piamio.fi/en/services/tourism/piamio_sanatorium [Accessed 12 October 2015] 16 Hobday, 2006, p. 57.
23
published in 2015 evidenced that shift workers who do not receive adequate
the cardiovascular system, and is an area that requires further research
amounts of light during daytime hours are at greater risk of developing
and understanding.24 More recently, Richard Weller from the University of
internal cancers.17 Similar results have been found in those who nap
Edinburgh has driven further research into the relationship between UV and
frequently during the day and those who do not receive consistent daytime
cardiovascular health, suggesting in a 2012 Ted talk that increased sun-
light. However, not only has access to light during daytime hours been
seeking behaviour correlates with longer life span, even at the risk of skin
found to prevent cancer, but also help the healing process. Professor Johan
cancer.25
the architecture of light
Moan and the Institute for Cancer Research in Norway (2005) found that sun exposure throughout summer months increased the survival rate for
SEASONAL AFFECTIVE DISORDER AND DEPRESSION
colon cancer- discovering that the risk of a Norwegian dying of colon cancer
Seasonal Affective Disorder (SAD) is defined by the Mayo Clinic as
was reduced as much as half if treatment began during summer months
‘depression that is linked to changes in the seasons and light levels’.26 Light
due to higher levels of UV light being received.18 Richard Stevens at the
therapy is commonly used in treating SAD and clinical depression.
University of Connecticut also found in 2005 that females who work night
Although antidepressants are also used to treat seasonal and non-seasonal
shifts for the majority of their working lives have 30-80% greater chance of
depression, the American Journal of Psychiatry found in 2005 that light
developing breast cancer than women who worked normal daytime hours.19
therapy has an equal effect to medication in treating depression.27 The study
These studies show there is a clear positive relationship between daytime
concluded that bright light therapy in conjunction with anti- depressants is
light and the development and recovery from cancer, however they neglect
a more effective treatment for SAD than anti- depressants alone. Another
that in return over exposure to light during nightime hours could have
study published in 2014 led by Stefan Knapen at Gronigen University,
negative effects for health. Professor Richard Stevens at the University of
Netherlands, proved again that depression severity decreased vastly after
Connecticut Health Center notes that environments with high levels of light
treatment of bright light therapy. However, the research also hypothesised
at nightime allow for the ‘exposure of the retina to photons that might disrupt
that ‘expectations play a role in speed of therapy response’28 questioning
circadian rhythm’.20
whether the positive results were due to the light alone or were aided by the expectation of an effect. In addition to this, the limitations of these research
CARDIOVASCULAR HEALTH AND HEART DISEASE
journals for architects are that they do not question the effectiveness of
In addition, sunlight has also been shown to improve cardiovascular health
artificial light in comparison to natural light, the outcome of which would
and prevent heart disease. Vitamin D gained from light exposure can
affect healthcare design hugely.
lower blood cholesterol, blood pressure and muscular function; factors all linked to developing heart disease.21 The Journal of the American College of Cardiology published a report in 2003 on the link between Vitamin D deficiency and cardiovascular health, highlighting that Vitamin D deficiency is a common issue that is not treated and often results in heart disease.22 Vitamin D receptor cells discovered in myocardial tissue23 suggests that Vitamin D plays a more important role than was previously assumed in 17 Wang, Ren, and Lin (2015) ‘Night-shift work, sleep duration, daytime napping and breast cancer risk’, Sleep Medicine: p. 462-468. doi: 10.1016/j.sleep.2014.11.017 18 Hobday, 2006, p. 62. 19 Sternberg, 2009, p. 50. 20 Chepesiuk, R. (2009) ‘Missing the dark: Health effects of light pollution’, 117(1). 21 Hobday, 2006, p. 60. 22 Lee, O’ Keefe, and Bell, (1949) ‘Vitamin D Deficiency’, Journal of the American College of Cardiology, 52(24), pp. 1949-1956. doi: 10.1016/j.jacc.2008.08.050 23 Definition: Muscle cells that form the bulk of the heart wall in Myocardium (no date) Available at: http://medical-dictionary.thefreedictionary.com/myocardium [Accessed: 13 January 2016]
24
24 Wallis, Penckofer, and Sizemore, (2008) ‘The “Sunshine Deficit” and Cardiovascular Disease’, Circulation, 118(14), pp. 1476-1485. doi: 10.1161/CIRCULATIONAHA.107.713339 25 Weller, R. (2013) Ted Talk: Could the sun be good for your heart?. Available at: https://www. ted.com/talks/richard_weller_could_the_sun_be_good_for_your_heart?language=en [Accessed: 16 January 2016] 26 Mayo Clinic (2014) ‘SAD Definition’, Mayo Clinic. 27 Arehart- Treichel, J. (2005) ‘In treating non-seasonal depression, let the light shine in’ Available at: http://psychnews.psychiatryonline.org/doi/full/10.1176/pn.40.17.00400014a [Accessed: 24 October 2015] 28 Knapen, S. E. (2014) ‘The duration of light treatment and therapy outcome in seasonal affective disorder’, Journal of Affective Disorders, 166, pp. 343–346. doi: 10.1016/j. jad.2014.05.034.
25
2.3. EVIDENCE FOR THE POSITIVE EFFECTS OF LIGHT ON MOOD, STRESS AND PAIN RELIEF
2.4. HOW ARE HEALING AND MOOD IMPROVED BY LIGHT?
This section analyses research that demonstrates the positive effect of light
The last two sections have studied the positive effect light has on healing
on mood- particularly stress levels and the effect of mood on pain relief.
processes and mood, and this section will outline how healing and mood are improved by light.
STRESS A study in the Annals of Behavioural Medicine published in 2006 demonstrated
VITAMIN D
that stress as a result of pain, or any other origin, produces hormones
Heliotherapy32 used in the twentieth century was believed to help cure TB,
that slow the functioning of the immune system, and therefore restrict
however it was later found to actually be aiding the body’s healing process
healing processes.
29
Stress decreases with improvement in mood, and
in general rather than specifically targeting a TB infection. Chemical
this study verified that mood is improved with bright light as a result of
reactions occur as a result of the energy the sun provides when it hits
endorphins and serotonin chemicals being released as a response to light
our skin, initiating the Vitamin D molecule in our skin to become active.
in the brain. It is well documented that patients suffer stress as a result of
Vitamin D allows for absorption of calcium into the bones and vitalisation of
illness; so reducing stress through the use of light could aid the emotional
the immune system which helps to speed the healing process.33
and physical healing from illness. ‘Stress’ is referred to in this context as ‘the process of reacting to the environment and other factors that are demanding, 30
challenging, distressing or threatening.’
It is evident there is crucial
CIRCADIAN CYCLES - BODY CLOCK Our bodies operate around a circadian cycle, a time period of roughly 24
relationship between mood, stress and light.
hours. The SCN (suprachiasmatic nuclei) within the hypothalamus in
the architecture of light
the brain can be thought of as the body’s ‘master clock’ and controls the
MOOD AND PAIN RELIEF
secretion of chemical messenger melatonin in response to light levels.
Researchers have drawn a link between daylight and reducing pain relief
Melatonin binds with receptor cells in organs to pass on a ‘message’ and
medication in nursing homes and hospitals. A study published in the
create a biological response.34 If the body’s circadian clock is disrupted
Journal of Psychosomatic Medicine (1995) indicated that patients undergoing
with unusual levels of light, melatonin is produced inappropriately and can
spinal surgery ‘staying on the bright side received 46% more natural sunlight
cause mood changes, interrupted sleep patterns, and if becomes disrupted
and required 22% less opioid equivalent analgesic medications during their
regularly can affect general health.35 However to produce the important
hospitalization. The patients staying on the bright side also experienced a 21%
chemical melatonin the body requires serotonin, a neurotransmitter that 31
reduction in analgesic medication cost compared with patients on the dim side.’
helps cells to function. In 2002, the Baker Heart Research Institute in
It is suggested that the alleviation in pain is due to uplifted spirits as a
Australia found the amount of bright sunlight received by subjects each day
result of higher daylight levels.
related proportionally to the production of serotonin.36 Levels of serotonin have been reported to increase with sunlight seasonally and daily, so serotonin, and therefore melatonin levels can be considerably higher during summer months. Lack of serotonin has been proven to cause depression, anxiety, pain perception and aggressive behaviour. However the circadian cycle can be negatively affected by exposure to artificial light at night. Dr.
29 McGuire, L. (2006) Pain and wound healing in surgical patients, Ann Behav Medicine [31 April 2006] p. 165- 72.
26
32 Definition: The therapeutic use of light in Oxford Dictionary. Available at: http://www.oxforddictionaries.com/definition/english/heliotherapy [Accessed: 13 January 2016]. 33 Sternberg, 2009, p. 51.
30 Ulrich, 1999, p. 32.
34 Hobday, 2006, p. 28.
31 Daylight benefits in healthcare buildings (2015) Available at: http://www.designingbuildings. co.uk/wiki/Daylight_benefits_in_healthcare_buildings#Daylight_and_pain_relief [Accessed: 13 October 2015].
36 Lambert, Reid, and Kaye, (2002) ‘Effect of sunlight and season on serotonin turnover in the brain’, The Lancet, 360(9348), pp. 1840-1842. doi: 10.1016/s0140-6736(02)11737-5
35 Ibid, p. 28.
27
Charles Czeisler, Harvard Medical School (1981), proved ‘that daylight keeps
2.6. CONCLUSION
a person’s internal clock aligned with the environment’ and therefore exposure 37
to light at night can be detramental to the circadian cycle and also overall
The presentation of research in this chapter evidences that light has a
health. Stephen Lockley, Harvard sleep researcher, has suggested that even
wide power in enhancing healing processes across a range of illnesses,
light as low as levels of 8 Lux can affect the body at night.
as well as preventing the development of these health issues. Research
38
has also demonstrated that light has the power to enhance our mood, and
SUNLIGHT AS A DISINFECTANT
a positive outlook can improve the functioning of our immune systems.
During the First World War it was commonplace for military surgeons
Despite the positive effects of light it is important to recognise that there is
to place infected wounds out in direct sunlight to disinfect them, as the
also evidence for the negative effects of light during nightime hours, with
ultraviolet radiation from sunlight is a natural disinfectant. In Notes on
exposure to light at this time having the ability to alter the circadian cycle
Hospitals Florence Nightingale recognised the importance of access to
and and thereby affect sleeping patterns and general health. Recognising
direct sunlight to help disinfect hospitals.
and understanding the spectrum of research is vital for architects and
39
The disinfecting properties of
sunlight are now commonly used to disinfect water, eliminating biological
designers to create focused healthcare environments that can aid healing
pathogens. Research has shown it is not the sun’s heat that kills the
and outlook.
bacteria, but the sunlight itself.
40
the architecture of light
2.5. EVIDENCE THAT POSITIVE EMOTIONS CAN IMPROVE HEALTH AND HEALING This section analyses the impact mood can have on healing and whether it is primarily mood and well being improved by light that aids healing processes. Hormones can influence the response of the immune system significantly. As hormones are released with mood changes it is valid to suggest there is a link between mood and healing. Scientist Richard Davidson at Emory University provided evidence to support this finding that compassion meditation, which involves focusing the heart and mind to become more compassionate, improves immune function.41 If healing and positive emotions influence one another, it is important to create healthcare environments that are pleasant and uplifting for people to be in, aiding the overall healing process.
37 Harvard Health Publications (2012) ‘Blue light has a dark side’ Available at: http://www. health.harvard.edu/staying-healthy/blue-light-has-a-dark-side [Accessed: 13 January 2016]. 38 Ibid. 39 Nightingale, F. (1863) Notes on Hospitals (Third Edition) Longman, Roberts and Green. 40 Hobday, 2006, p. 70. 41 Sternberg, 2009, p. 213.
28
29
3
WINDOWS 3.1. INTRODUCTION
In 1984 Science magazine published one of the first studies to explore the relationship between physical space and healing. The study was led by Roger Ulrich in which the ‘restorative effect of natural views on surgical patients was examined in a suburban Pennsylvania hospital’ by comparing the length of stay, analgesic doses and nurses notes between patients recovering after
the architecture of light
cholecystectomy (gall bladder removal), whose windows gave either views of a brick wall, or trees (shown in Figure 6 below).42
FIGURE 6: Plan of the second floor of the study hospital showing the trees versus wall window views of patients.
The 23 patients whose windows looked onto natural scenes healed more quickly and required fewer analgesics than the other 23 matched patients who had views of the brick wall. The outcome of the study suggested that the healing process was quickened by windows. Perhaps this is as a result of more than just light: could the effect be a result of fresh air ventilation, sounds, smells or even the distracting and calming effect of connecting with the rhythms of the natural world outside? This chapter examines the health enhancing factors provided by window openings other than light, and the effect these factors may have. 42 Ulrich, R. (1984) ‘View through a window may influence recovery from surgery’, Science, 224(4647), pp. 420-421. doi: 10.1126/science.6143402
30
31
3.2. FACTORS THAT AID HEALING AND WELL BEING PROVIDED BY WINDOWS
yellow-green range) was the first to emerge within the evolution of the eye,
This section looks to explore factors other than daylight provided by
colour that surrounds us in nature, hence why photoreceptor pigment genes
windows that may aid healing and well-being.
for yellow-green wavelengths were developed first in humans.46 Esther
followed by the blue range and finally the orange-red range. Green is the
Sternberg suggests in Healing Spaces that the reason why we heal faster
VIEWS OF NATURE
with views of trees and nature rather than brick walls is because green is
The Parahippocampal Place Area (PPA) is the area of the brain that
an intrinsically familiar colour that we have the most developed recognition
responds and recognises scenes. Research conducted on humans and
for. Colour therapies are becoming more commonplace as a way of reducing
monkeys showed that the PPA responds to scenes with higher spatial
stress and improving emotional wellbeing. Scientist Peter Mandel is the
frequencies, with greater responses to scenes with increased colour, depth
pioneer of ‘Esogetic Color Puncture’, a kind of colour/light therapy that
43
the architecture of light
and movement.
The PPA releases endorphins in response to pleasing and
stimulates acupuncture points through the use of coloured lighting from
beautiful scenes, helping improve moods and therefore helping healing
which patients claim to have improved physical symptoms and emotional
processes. Figure 7 shows how the PPA responds more positively to cubes
outlook.47 Colour and fractals in nature are perhaps why we find nature
rather than to spheres. This can be translated into how the brain has a
scenes relaxing and familiar, and hence why they may help improve healing
greater response to symmetrical, repeating patterns in natural scenes.
and wellbeing.
FIGURE 7: Diagram showing PPA activity.
These patterns forming elements in nature such as trees, snowflakes, flowers and plants are referred to as fractals.44 Professor of Cardiology at Harvard, Ary Goldberger (1996), has suggested that because our brain has a fractal structure, we receive fractal information better, and find it intrinsically satisfying.45 Colour is another element of scenery that humans have been found to respond positively to. It is generally recognised that green and blue are cool, calming colours, in contrast to the bright, energising hues of red and yellow. This is because the photoreceptor gene that responds to the wavelengths of lights reflected from plants (the 43 Rajimehr, Devaney and Bilenko, (2011) ‘The “Parahippocampal Place Area” responds preferentially to high spatial frequencies in humans and monkeys’, PLoS Biology, 9(4), p. e1000608. doi: 10.1371/journal.pbio.1000608. 44 Sternberg, 2009, p. 34. 45 Salingaros, N. A. (2013) Fractal Art and Architecture reduce Physiological Stress. Available at: https://journalofbiourbanism.files.wordpress.com/2013/09/jbu-ii-2012-2_nikos-a-salingaros.pdf [Accessed: 29 October 2015]
32
FIGURE 8: Ary Goldberger suggests that we find scenes with increasing colour, depth and movement intrinsically pleasing.
AIRFLOW AND VENTILATION Good ventilation and clean air supply can help improve the efficiency of the immune system by optimising the function of white blood cells through a good, clean supply of oxygen, and also allowing the heart and lungs to function more easily by removing impurities in the air such as car fumes 46 Sternberg, 2009, p. 38. 47 Colour Puncture Therapy (no date) Available at: http://colorpuncture.org/ [Accessed: 9 December 2015]
33
and dust. Studies show that fresh air gives feelings of vigour and can energise people, giving a sense of energy and purpose.
48
Lourdes in Southern France is an example where the expectation of healing
This could help
comes to play in increasing the healing effect. Memory and expectation
reduce healing time by inspiring a positive and optimistic mind set.
encourages association between place and healing, and the legendary healing stories of Lourdes are well known.54 This can be translated to the
CONNECTION TO THE OUTSIDE WORLD
benefits of windows, as windows achieve a view of the natural world that
The sounds and smells that come in through a window provide a patient
could be associated with positive memories, encouraging an expectation of
recovering from illness with a sense of the outer world: a gauge of when
healing.
day falls to night, meal times, external habits and routines associated with noise outside such as traffic or owls hooting in the evening hours. Healing is described as a turning point by Esther Sternberg in Healing Spaces, saying it
3.3. HOW MUCH LIGHT DO WE NEED
is ‘a turning of your mind’s awareness from a focus on your inner self to a focus on
Having recognised all the factors provided by windows that may
49
the outer world.’
If the first sign of healing is the ability to take an interest
help healing and general well being it is important to understand the specifications of openings that allow optimum levels of light. Orientation,
in the outside world, windows provide the ability to do so.
window size, location and window to wall ratio are important factors.
the architecture of light
DISTRACTION AND EXPECTATION Distraction from pain or worry could be seen as another benefit of windows
ORIENTATION
in improving mood and outlook. However, expectation of healing can also
The orientation of streets and cities is essential in allowing sufficient levels
come into play in helping speed up recovery time, as it can work as a kind
of light into environments to benefit health and psychological outlook.
of placebo effect. The placebo effect is a complex phenomenon whereby we
Direct sunlight dries moisture absorbed by brick and concrete walls, and
may feel better as a result of ‘believing that something will heal’ us, account for 30% of the curative effect of any drug.
51
50
and can
without it houses can become damp in wet climates, causing damage and poor health. Historically, it was generally thought that to be able to get
When expectation of
being cured occurs, nerve cell electrical activity increases and can affect the
the most amount of sunlight possible one would need to be able to see the
endogenous opioid pathways that control pain, and the dopamine reward
sun rise, and as far back as the 4th century B.C. Hippocrates concluded
pathways controlling addiction and desire, culminating in a healing effect.
52
In 2004 Italian neuroscientist Fabrizio Benedetti compared the effects of
that cities orientated toward the rising sun were healthier than any other orientation.55
a Parkinson’s drug on patients to a disguised placebo drug (made up of saline). Benedetti found the same positive outcome occurred in some of the patients who received the placebo as those who received the real drug. Benedetti’s study showed that the expectation of a positive effect occuring from the Parkinson’s drug released nerve chemicals that had a therapeutic healing effect.53 Expectations can be created through past experience, memories, history, culture or even general belief. The famous healing town 48 Ryan, Weinstein, and Bernstein (2010) ‘Vitalizing effects of being outdoors and in nature’ Journal of Environmental Psychology, 30(2), pp. 159-168. doi: 10.1016/j.jenvp.2009.10.009 49 Sternberg, 2009, p.1. 50 Ibid, p. 193. 51 NHS Choices, (2015) Complementary Medicine and Placebo Effect- Live Well- NHS Choices. Available at: http://www.nhs.uk/Livewell/complementary-alternative-medicine/Pages/placebo-effect. aspx [Accessed: 4 January 2016] 52 Sternberg, 2009, p. 198. 53 Benedetti, Colloca, and Torre (2004) ‘Placebo- responsive Parkinson patients show decreased activity in single neurons of subthalamic nucleus’, Nature Neuroscience, 7(6), p. 578588. doi: 10.1038/nn1250.
34
FIGURE 9: William Atkinson’s Shadow Diagram.
FIGURE 10: William Atkinson’s Shadow Curves.
54 Lochran, J. (2008) The Miracles of Lourdes: A Message of Healing and Hope. Cincinnati, OH: St. Anthony Messenger Press. 55 Hobday, 2006, p. 84.
35
Figure 9 shows William Atkinson’s mapping system of shadows on a
WINDOW TO WALL RATIO
building aligned square with the meridian, and a building where the
Window to wall ratio is defined as the ratio of vertical fenestration area
meridian passes through the diagonal. The building that lies on a diagonal
to gross exterior wall area.58 The window to wall ratio demonstrated in
to the compass will receive sunlight to all sides of the building at some
Figure 12 affects the amount of lighting, heating and cooling in a building,
point during all seasons of the year, whereas the building orientated
and determines the quantity of daylight, ventilation and views. When
square on the meridian will not receive any daylight on the north wall from
considering light in design it is important to understand the optimum
autumn till spring, roughly half the year. Atkinson recognises this as the
window to wall ratios, which is thought to be less than 27%, otherwise glare
optimum orientation and layout for buildings, streets and cities to receive
and overheating becomes a problem.59
light throughout all seasons of the year and to remain clean and dry.56
WINDOW OPENINGS Daylight distribution is an important factor to consider in design, as it cannot be presumed that light will be able to penetrate an entire room from window openings. Light distribution is dependant on sky conditions, orientation and location of windows within a structure and the height, width and depth of the window. The useful penetration of daylight from a side window is considered to be 1.5 times the head height of the window.57 As architects it is critical to appreciate how the size, orientation and location
the architecture of light
of windows will affect the amount of light a room will receive. Light shelves,
FIGURE 12: Diagram showing Window to Wall Ratio.
prisms and mirrored louvers are systems that can also be considered to help deflect light deeper into a room, and should be important design considerations when thinking of designing for healthcare environments. Figure 11 shows how a mirrored louver system works to reflect light deeper into a room.
3.4. EVIDENCE BASED DESIGN This section will define what evidence based design (EBD) is, and how it can be used in design processes to encourage the provision of health giving factors such as light in buildings. EBD is a developing field of design that ‘utilises evidence to make informed design solutions’.60 Using evidence based design is a way of enveloping research and studies to produce intelligent design outcomes that could help aid healing and emotional health. Gordon Chong notes in Design Informed: Driving Innovation with Evidence- Based Design that architects ‘depend on intuition and personal project to make design choices’ rather than using evidence to make decisions on design.61 Chong also discusses that ‘biomedical research connecting daylight and health’ could be put to greater use in
FIGURE 11: Diagram of a mirrored louver system.
36
58 Fenestration and Window to Wall Ratio, (2011) Available at: http://energy-models.com/forum/ fenestration-and-window-wall-ratio#comment-9366 [Accessed: 8 December 2015]. 59 Green Garage (no date) Sustainable window design. Available at: http://greengaragedetroit. com/index.php?title=Sustainable_Window_Design [Accessed: 4 January 2016]
56 Ibid, p. 82.
60 Evidence Based Design, Available at: http://ebdjournal.com/ [Accessed: 10 December 2015]
57 Boubekri, M. (2008) Daylighting, Architecture and Health. Amstedam: Architectural Press, p. 114.
61 Chong, G. (2010) Design Informed: Driving Innovation with Evidence-Based Design, e-book, http://NCL.eblib.com/patron/FullRecord.aspx?p=624385 [Accessed 10/12/15]
37
specific design strategies through the use of EBD.62 The Maggie’s Centres demonstrate a form of EBD which envelopes information from research to create an effective healing environment. The Royal Jubilee Hospital in Vancouver is one of the first healthcare environments designed using EBD. Completed in 2010, the project stayed on schedule and to budget, and has had positive health outcomes alongside winning a variety of design awards.63 The hospital includes 100% fresh air ventilation, rainwater
the architecture of light
harvesting and offers patients autonomy of their environment.64
FIGURE 14: The entrance/ waiting area in the Royal Jubilee Hospital is spacious and filled with light.
FIGURE 13: Private en-suite hospital room with large bedside windows in the Royal Jubilee Hospital, Vancouver.
3.5. CONCLUSION This chapter has demonstrated that there is more to the benefits of window openings than solely the provision of light: views of nature, colour, ventilation and fresh air, a connection to the outside world, distraction and expectation are all factors delivered by windows that can, in addition to light, help aid healing and emotional wellbeing. It is important to acknowledge optimum specifications for windows to take full advantage of theses factors. Evidence based design is the next step for architects which can draw research together with design to make informed design decisions benefiting health and well being. 62 Ibid. 63 Johnson, B. (2012) ‘Healthcare quarterly, Vol. 15 special issue | excellent care for all’, Healthcare Quarterly, 15 (Special Issue). 64 Royal Jubilee hospital patient care centre achieves LEED gold | H.H. Angus & associates Ltd (2016) Available at: http://www.hhangus.com/royal-jubilee-hospital-patient-care-centre-achievesleed-gold/ [Accessed: 13 January 2016]
38
39
4
METHODOLOGY 4.1. METHODOLOGY VISITING THE MAGGIE’S CENTRES Visiting the Newcastle, Dundee and Edinburgh centres posed an opportunity to experience the centres first hand, giving greater insight into how the centres worked, and which features that were most successful.
COMPARING USE OF LIGHT The use and provision of light in the centres was compared based on three the architecture of light
criteria: window to wall ratios, views and orientation. As surveying the spaces would not have been appropriate whilst there were visitors in the centre, the window to wall ratios were estimated for each centre by using photos, sections and plans. The views and orientations were compared based on photos, plans and personal observation.
INTERVIEW PROCESS Having the ability to spend the most time at Maggie’s Newcastle offered the opportunity to interview Centre Head Karen Verrill. As a result of the FIGURE 15: Newcastle Maggie’s Centre.
Maggie’s Centre being on NHS grounds, interviewing patients required an NHS ethics form and given the time constraints for this piece of work permission could not be obtained to do so. However, interviewing staff did not require this application and this also give an equally reliable and interesting way to gain insight into how the design of the centre affects mood and health. The interview with Karen stemmed from the research presented in Chapters 2 and 3, and on the central themes of natural light, autonomy of space and access/ views of nature as outlined by Roger Ulrich. The full interview can be found in Appendix A.
FIGURE 16: Dundee Maggie’s Centre.
40
FIGURE 17: Edinburgh Maggie’s Centre.
41
4.2. INTERVIEW WITH KAREN VERRILL This section selects parts from an interview with Karen Verrill, Centre Head of Maggie’s Newcastle, which are relevant and reinforce the idea that light alongside design can help enhance mood and healing processes.
ATMOSPHERE IN MAGGIE”S Talking to Karen she told me how one lady described coming into Maggie’s as ‘walking into my mother’s arms’. I thought it was important to note the welcoming and safe atmosphere the centre clearly makes it’s visitors feel, as this will help reduce stress and help well being.
HEALTHCARE DESIGN WOULD BENEFIT FROM CHANGE Having worked as an NHS nurse in all sorts of different fields before joining the Maggie’s team, Karen believes that patient orientated design would also benefit staff and families in healthcare environments saying ‘if hospitals took a leaf out of the Maggie Centres and built like this it would be much better for people all round- not just the patients but friends and families, and the carers.’
the architecture of light
IMPORTANCE OF ORIENTATION FOR LIGHT Asking Karen about light provision in the building she says ‘we get maximum light at all times’ and reinforces the importance of light in getting people to use spaces in the centre saying ‘the gardens in the summer are always used well because of the way they face South-West...so in the summer people use the outside space in a big way- put chairs out there, sit in the roof gardens, they’ll have their
FIGURE 18: Section of Newcastle centre highlighting the importance of the sun.
lunch in the roof garden.’
SAFETY Talking to Karen about how the architecture of the centre makes her feel, she tells me ‘I feel warmth from the building, I feel safe. It’s light, it’s big, it’s solid and it feels almost safe.’
MOOD LIGHTING The lights in the centre are dimmed at 4pm to a softer, yellower light that brings down the mood at night time: ‘There’s mood lighting here so as the day goes on the light softens and so does the mood of the place.’ Karen also reinforces the importance of autonomy for visitors in the centre over being able to turn lights on/ off, shut blinds/ curtains and open windows to suit their preference, whcih Ulrich highlights in his research as being critical in allowing people to feel comfortable and relaxed.
42
43
5
CASE STUDY: MAGGIE’S CENTRES 5.1. MAGGIE’S CENTRES
The Maggie’s Centres are cancer care facilities within the grounds of NHS cancer hospitals. They are spaces designed to act as ‘retreats’ for patients, families and friends to receive emotional support and advice outside the hospital environment. The centres form a new kind of ‘hybrid architecture’65 combining architecture, landscape and art to create environments that nurture those suffering from cancer, as well as their carers. Using the the architecture of light
Maggie’s Centres in Newcastle, Dundee and Edinburgh as case studies allows the basis to evaluate whether a building designed to comfort, heal and uplift those suffering from illness achieves it’s aim in doing so, and understand first hand the effect light as an architectural tool can have on the healing process and mental attitude.
HISTORY Maggie Keswick Jencks was the founder of the Maggie’s Centres. Five years after overcoming the cancer she was diagnosed with in 1988, Maggie received another diagnosis of metastatic breast cancer and doctors predicted she would only have a few months to live. Years of experiencing dark, windowless waiting rooms and lifeless, white clinical wards inspired Maggie to conceive a space where those suffering from cancer could receive support and advice away from the hospital environment. Collaborating with her husband Charles Jencks (an architectural theorist and landscape architect) alongside her medical team in the Western General Edinburgh, the first Maggie’s Centre in Edinburgh was designed. FIGURE 19: Maggie Keswick Jencks in her garden in Portrack, Scotland. Photo courtesy of Maggie’s centre.
65 Heathcote and Jencks, 2010, p. 28.
44
45
AIM’S
5.2. COMPARING THE USE OF LIGHT IN CENTRES
Maggie’s goal was to create an environment that is drastically different to
The Newcastle, Dundee and Edinburgh centres will be compared by looking
that of a hospital: a familiar, domestic space that uses architectural features
specifically at window to wall ratio, orientation and views available from the
typically found in homes such as smooth textures, a mixture of soft,
centres, all factors which this work has previously cited to be important in
neutral and vibrant colours, homely furniture, views of nature and access
creating healing and nurturing healthcare environments.
to natural light. ‘Kitchenism’ is the core idea on domesticity in the centres, and envelopes the idea of a kitchen having a welcoming, comforting
WINDOW TO WALL RATIO
atmosphere, something which the Maggie’s Centres aim to recreate.
The window to wall ratio (WWR) is recommended to be between 0.20-
Removing formal spaces such as a reception, closed off staff areas and signs
0.30, as if it is higher than this too much light will result in glare and there
in the centre helps the centres to achieve separation from the clinical and
will be considerable heat loss during the winter months.67 Using sections,
formal atmosphere of hospitals that patients are used to.66
pictures and measurements from my visits to the centres to estimate WWRs, the WWRs were estimated to be 0.33 in Newcastle, 0.25 in Dundee
BRIEF
and 0.20 in Edinburgh. All being within or close to the recommended range
Each of the architects selected to build a Maggie’s Centre are given a
highlights the importance of light as a tool to enhance mood and healing in
general brief (see Appendix B), which is unprescriptive in comparison to a
the architecture of Maggie’s.
typical brief. Instead they focus on the feel of the centre and the individual environments inside, highlighting the importance of incorporating as much
VIEWS
light as possible, views of nature, and gardens that are integrated as an
Maggie’s takes full advantage of the natural soothing and healing powers
extension of the centre.
offered to us by views of nature, and the intrinsic satisfaction provided
the architecture of light
by deep landscape views with varying colour, movement and depth. Landscaping in the centres is as important as the architecture, and prompts the important question of whether windows have the same health giving benefits without a view.
ORIENTATION As discussed in Chapter 3 orientation is crucial in allowing spaces to receive optimum amounts of light. All the centres have a careful consideration of positioning and orientation of space to achieve heat gain and light into the buildings, whilst roof pitches and overhangs prevent glare and the overheating of the spaces.
66 Kreibich, W. (2015) ‘Can Architecture Make You Feel Better?’ Sheffield University, p. 9-11.
46
67 Green Garage, Sustainable Window Design.
47
5.3. MAGGIE’S NEWCASTLE BY TED CULLINAN STUDIOS Analysing the window to wall ratio (WWR), orientation and views of the Newcastle Maggie’s centre.
WINDOW TO WALL RATIO The WWR was estimated to be the highest of the three centres being compared. Sky lighting and full height windows extending through double height spaces are perhaps why the WWR is highest in this centre.
ORIENTATION The centre is planned in an ‘L’ shape, which allows for a sheltered courtyard garden space in the middle angled towards the South for the best possible provision of sunlight throughout the day. The important spaces such as the kitchen, library and counselling rooms all face out in this direction, offering a view of the gardens and high levels of light throughout the day. The North facing sides of the centre are sloping earth banks, which insulate the building and add to the feelings of safety and privacy in the centre. The double height library space is the first area of the centre that is entered, and is filled with daylight due to the large feature windows facing Souththe architecture of light
East (see Figure 20). Even visiting the centre on a relatively wet and dark afternoon in November, the centre is warm and filled with light, and it is evident that the orientation of the building and positioning of the windows is crucial to allowing natural light within the building.
VIEWS The Newcastle centre is effectively placed in the carpark of the NHS Freeman Hospital, and with little potential for expansive views the centre manages to achieve the illusion of an oasis amongst the urban landscape through the sunken garden around piled earth that blocks views of surrounding buildings. The kitchen, library and counselling rooms all give views onto the garden area, providing a stress relieving and comforting view of nature as discussed in Chapter 3.
48
FIGURE 20: Double height library space in Newcastle Maggie’s Centre, photographed in the evening showing how mood lighting lowers the atmosphere of the centre.
49
the architecture of light
FIGURE 22: Images showing the light quality throughout the library and staircase area of thre centre.
FIGURE 23: Plan of the centre by Ted Cullinan Studio.
FIGURE 21: Stairs leading out of library space with integrated bookshelf.
FIGURE 24: Kitchen, garden and counselling room.
50
51
5.4. MAGGIE’S DUNDEE BY FRANK GEHRY WINDOW TO WALL RATIO The WWR was estimated to be within the optimum range at the Dundee centre, as similarly to the Newcastle centre large feature windows are a core part of Gehry’s design.
ORIENTATION The main feature in the Dundee centre is the South extending cylindrical form as found in the ancient primitive and protective ‘Highland dwellings known as brochs’.68 Similarly to the kitchen space in the Newcastle centre, windows facing South- West line an entire side of the room supplying the space with natural light, with the overhang of the roof preventing glare and providing a protective element. Like the library in the Newcastle centre the library (situated at the base of the cylindrical tower) also faces South creating an uplifting environment filled with light.
VIEWS Perhaps the most notable space in the Dundee centre is the sitting room the architecture of light
above the library shown in Figure 26. The large feature window faces South towards the Tay Estuary, and two seats set facing out with binoculars and a map of the scenery on a nearby table encourages visitors to spend time appreciating the view. The Dundee centre offers the most exciting views of the Maggie’s Centres in this comparison due to it’s situation and orientation.
FIGURE 26: Kitchen, sitting room, and staircase in Dundee Centre.
FIGURE 25: South facing towerat the Dundee Maggie’s Centre.
52
68 Treggiden, K. (2013) Maggie’s: Dundee. Available at: http://confessionsofadesigngeek.com/ maggies-dundee/ [Accessed: 7 January 2016].
53
5.5. MAGGIE’S EDINBURGH BY RICHARD MURPHY
FIGURE 26: Sketch of Edinburgh centre by Richard Murphy. Murphy’s core focus was that the building was not to have the feeling of being an institution; therefore there are no corridors or signage throughout the building in order to give it a more homely feel.
WINDOW TO WALL RATIO Having the lowest WWR of the centres is perhaps a result of being an extension from an existing building and therefore having encountered the architecture of light
more restrictions of placement, size and orientation of windows. The WWR decreased with the age of the centres, and it could be questioned that this is a result of a higher respect for the importance for light as more centres have been developed.
ORIENTATION The extension completed in 2001 saw rooms built out towards the South of the site to provide the maximum amount of sunlight possible, and even the monopitch of the roof was designed to allow light to be admitted from
FIGURE 28: Kitchen, double height central space, staircase, and garden seating area through a window.
the South into North facing rooms.69 Similarly to the other two centres I’d visited, the kitchen featured windows along the South façade, some being opaque to prevent too much glare in summer months yet still providing a glow of light.
VIEWS Similarly to the Newcastle centre, the Edinburgh Maggie’s is effectively an extension to the Western General car park. However the centre also achieves the sense of an oasis with tall hedges and plant covered walls blocking views of the hospital. Figure 29 shows plans to extend the garden space. 69 Richard Murphy Architects (1997) Richard Murphy Architects: Maggie’s Cancer Caring Centre, Edinburgh. Available at: http://www.richardmurphyarchitects.com/viewItem.php/viewItem. php?id=2452 [Accessed 8 December 2015]
54
FIGURE 29: Drawing of planned extension: proposal of a garden house.
55
5.6. CONCLUSION Analysing three of the centres highlighted the importance across the Maggie’s Centres of windows, specifically in terms of size, orientation and views available in order for the centres to gain valuable levels of natural light. Throughout the comparison of the centres it was noted that views of nature, even of a garden if views of a landscape were not available, is an important environmental feature of the centres, with the Edinburgh centre even proposing plans to develop the garden space to help obstruct views of
the architecture of light
surrounding buildings and provide a calming retreat for visitors.
56
57
6
CONCLUSION EVIDENCE BASED DESIGN Evidence based design is a process if used in the design of healthcare facilities that has the potential to change healthcare and the way our places of healing are designed forever.70 Basing design on facts and research: whether creating spaces that provide adequate levels of light, views and ventilation or designing spaces particularly so that patients wash their hands to prevent the spread of infectious diseases calls for a greater
the architecture of light
interface between architecture and medical fields.
ROGER ULRICH’S RESEARCH Thirty years on from releasing his work on ‘View through a Window May Influence Recovery from Surgery’, Dr. Ulrich remains at the forefront of research in this field, and is beginning to encourage evidence based design as part of a curriculum for design students in education. In an interview by Healthcare Design Magazine, Ulrich notes ‘architects and designers generally don’t read much research’.71 Perhaps the root of the problems in tackling health orientated design is the design industry’s lack of knowledge of scientific research. This is a crucial advancement that must be made if evidence based design is to be used to create specific healthcare environments that have the capability to heal and comfort.
LIGHT, HEALING AND MOOD Throughout the research for this work the ‘what if…’ question has been posed; what if designers were to take responsibility for our health, how different would our healthcare environments look and to what ends? Looking into light as an architectural feature has reinforced how important 70 Van Den Berg, A. (2004) Health Impacts of Healing Environments, The Netherlands, p. 14. 71 Planning Clinics for Flexibility and Adaptability (2015) Available at: http://www.healthcaredesignmagazine.com/article/seeds-change-interview-roger-ulrich?page=2 [Accessed 8 December 2015]
58
59
light is for health across a whole range of illnesses from TB, cardiovascular
to embrace the practices of evidence based design to create environments
health, internal cancers, SAD disorder, depression, mood, stress and even
that have positive health effects based on relevant research. This has the
pain relief. This investigation into the effect of light on mood and healing
potential to improve healthcare systems such as the NHS by reducing
has encountered a whole range of other factors that also play equally
the average length of patient stays, overall health of communities and
important parts in the role of healing and wellbeing such as nature,
reducing long run costs. A revolution for our health and happiness is on the
ventilation, connection and views with the outside world, distraction and
architecture and medical profession’s doorstep; investing in evidence based
the pathways of expectation. It cannot be assumed that the only beneficial
design is the next step towards this, just as the Roman Empire invested in a
outcome of windows is light- many more factors come into play and are
right to light almost two thousand years ago.
equally important. These conclusions on light having an effect on health and healing have demonstrated importance of light as an architectural feature, encouraging comment on the greater overall issue of current healthcare design, and the need to practice evidence based design.
THE MAGGIE”S CENTRES The Maggie’s Centres are a modern example of patient focused design. Light is an important feature of each centre and it is specified in the brief that there should be ‘as much light as possible’ (Appendix B). It was clear after visiting centres, particularly after having the chance to speak
the architecture of light
with Newcastle Centre Head Karen Verrill, that Maggie’s really does have an effect on visitors mood and general well being, providing them with optimism for the future and hope. Having not expected to be completely overwhelmed by the power of the architecture in the space- it is not an over exaggeration to say that as soon as you step through the door you feel completely welcome, relaxed and at home in any of the centres. Comparisons cannot help but be drawn between the environments in NHS hospitals and the Maggie’s Centres, and whether hospitals could have the same effect on patients as the centres have on their visitors with a great potential for positive medical as well as psychological outcomes. Perhaps setting guidelines for provision of light into hospital and healthcare design briefs could be the next step to developing our healthcare environments, such as recommended wall to window ratios, wall openings and orientation of buildings.
A REVOLUTION FOR HEALTH AND HAPPINESS Throughout the research of this dissertation there has been an astounding quantity of research and studies presented that evidence the truly positive effect light has on psychological outlook and healing processes, and reinforce the power architecture therefore holds. Despite this, the lack of application of this knowledge in 21st century healthcare architecture is surprising. New developments for the architecture profession would be
60
61
APPENDIX A INTERVIEW WITH KAREN VERRILL, CENTRE HEAD AT MAGGIE”S NEWCASTLE Q. When you first started working at Maggie’s was there anything you noticed in particular that was different to other buildings you had worked in before? A: Before this job I was employed in the cancer centre as a specialist nurse the architecture of light
so I was working in clinics. I have been qualified for 35 years as a nurse and I’ve worked in operating theatres, accident and emergency, intensive care, all different kinds of specialities of theatres, I’ve worked in the community, in private hospitals, I’ve worked for a home chemotherapy company in a national role (so chemotherapy you can have at home). I’ve worked at the RVI, the general, Freeman, North Tyneside. I have never worked anywhere like this before, because everywhere else I’ve worked was very clinical other than visiting people at home when I worked in the community and I would never in all of my years as a qualified nurse have considered the impact this kind of building could have on people who are ill. And if someone had said to me four years ago it makes a huge difference I would have thought ‘well, how can it?’ They come into hospital, they need their treatment, they need to be looked after, they need to be given information/ advice/ support, but I never would have considered the huge impact this kind of place could have. From walking in here, thinking I didn’t think I wanted the job, thinking it was too touchy-feely, too there-there having been a very busy specialist nurse buzzing round getting everything done. I was struck when I walked in before there was any furniture or people in at the amazing feel this place has got. The first day I came in thinking I might turn the job down, I had tingles and hairs on the back of my neck walking into the kitchen and I just though wow what an amazing place to be part of. So I didn’t turn the job
62
63
down, took it and I’m still struck every day by the comfort and support the
patients but friends and families, and the carers. And I think these Maggie
building gives regardless of the people. And how people feel when they walk
Centres are incredible spaces and the Architecture design and gardens are
in. One lady said to me ‘Walking into this building I feel as if I’m walking
so far removed from what people experience in hospitals, and you can see
into my mother’s arms’. And it’s incredible the architecture and what it is
when people first arrive here- you can see it’s taken them a bit of courage
doing for people.
to come across from the hospital because they don’t know who we are, often they burst into tears but all of them take a huge sigh of relief. And you can
Q. That’s quite interesting what you’ve said about how the building even
see they feel relieved to have got to a safe place, where they can escape from
struck you without any furniture.
wards to come for a break. We had a man who used the Maggie’s regularly, he came to Maggie’s when he was diagnosed with cancer at the age of 20.
A: When I first walked in, I spoke to Ted Cullinan the Architect, at the
He came in very upset, he’d just been told. I spent some time talking him
time he was 83 and had cancer himself, he’s now coming close to 86. An
through the treatment and the options, and he said how much better he felt
incredible man, I really loved him, really warm person. He said he designed
now that he’d got a lot of information. But he used the centre a lot, he had
this particular Maggie Centre to appeal to men as well as woman hence all
lot’s of chemotherapy and radiotherapy- he ended up having to have his
the concrete and the wood. But it really had an amazing feel the first time
leg amputated, and his parents came into Maggie’s a lot as well. They came
I came in, and everybody who has come to the centre (and we’ve had close
here on the day when he was having his leg amputated because they said
to 50,000 people in the past 2 and a half years) all rave about the place. But
they got great comfort from here. Two days after his leg was amputated,
what’s most important is how welcomed, and how safe they feel as they
bearing in mind his ward was right at the other end of the hospital, so right
walk in.
at the front, the door burst open and he appeared through the door having
the architecture of light
hopped all the way from his ward down here. He said ‘I just had to get off Q. Do you think that patients would benefit from design like this in
the ward and get to Maggie’s’. And he would be here every day- the staff on
hospitals?
the ward knew if they wanted him, they’d find him here. We get such a lot of people from the wards coming to spend time, almost like a haven.
A: I do definitely. The cancer centre at freeman is a lovely new-ish, all singing all dancing, world-class cancer centre. And I think that’s true,
Q. You said that it is noticeable that as visitors come in their mood is
the treatment is great, they’ve got good teams and medical care. Although
uplifted and they have a more positive attitude by the time they leave- do
the building itself, although it’s nice and clean (it’s very clinical), the
you think that could have an effect on their healing process and the journey
outpatients waiting room where people sit sometimes for hours because
to getting well again from cancer?
it’s a very busy centre and there’s lots of delays, is like an airport waiting room. The seats are all joined together, you can even shuffle away from
A: Yeah I do. There’s lots of studies out there to say that positive thinking
someone, your sitting in there side by side. There are people in there who
and good mental attitude can help. And if you feel good about yourself
are more ill than others so some people find it quite distressing. And they
and you feel good mentally, it certainly helps physically. I do really think
just sit in rows and rows. Infection control has gone mad in hospitals, there
it makes a big difference to people and I think it can make a difference
not allowed curtains or flowers, or even little rugs anymore, everything
to them long term. They can come into Maggie’s for all kinds of specific
is very bare and very stark. For inpatients on the wards particularly, now
support, people come in here sometimes and don’t want to talk to anybody,
wonder they get depressed, no wonder their mood is low, when you think
they don’t want to join in anything, and they just want to be. And I say to
what could be done. I was qualified when we had the nightingale wards, the
the staff one of the skills of working in this centre is knowing when to talk
big rooms with lots of bed, but there was pictures, there was curtains and
to people and when to leave them be. But I do think this contributes to the
everywhere had a nicer feel (though nobody wants to be in hospital) but I
positive experience overall which can help.
think if hospitals took a leaf out of the Maggie Centres and built like this, even hospices, it would be much better for people all round- not just the
64
65
the architecture of light
Q: Are there any particular spaces in the building that you think visitors
Q: So from someone who has no previous design experience or knowledge,
enjoy being in the most?
what do you think it is about the Maggie’s here that is so special?
A: The whole centre is well used. The kitchen table is used by people who
A: It’s the feeling of the place. I love it when it’s empty as well as when it’s
want to sit and talk, and it’s very quiet today but we can have anything
full. I think what that lady said about walking into her mother’s arms aren’t
from 50-200 people using the centre in a day and that’s just between
quite the same for me because thankfully I don’t have cancer. But I think
the hours of 9-5pm. Some days I walk into the kitchen and I can see the
when I walk in here, I feel warmth from the building, I feel safe. It’s light,
kitchen table is full, with people who have never met each other before but
it’s big, it’s solid and it feels almost safe. The concrete I didn’t like but it’s
they’re all chatting and they’re getting support from each other. At the
grown on me, I’m still not 100% sure but I am old fashioned. But it lends
end of the day, cancer is cancer, it doesn’t matter where it is, the impact
itself to this building, and it gives the place a solid feel, so I think in here
and the devastation is the same for everybody. There might be a man with
I feel safe. The kitchen, I feel completely comfortable and welcome in the
a brain tumour talking to a lady with breast cancer, talking to someone
kitchen. And I feel like it’s mine. I’m fascinated now in Architecture through
with prostate cancer, but they all understand. So kitchen table is a place
what this has done for people. It’s also a talking point- when they come in
to come in, talk and socialise. By this time of day when it’s quieter people
it inevitably starts conversations by people coming and finding the staff and
often come in and sit and read quietly. This room here (private counselling
asking about the place, between visitors. I feel the wood, and the concrete,
room) people tend to go if they’re tired and need a lie down, have a snooze.
and I never would have done that in the past- I would have felt a patients
The garden room that is the smaller room round the corner is a lovely room
pulse, dressed their wounds, now I can stroke concrete, I can stroke the
where families often sit, visitors, families who have relatives in hospital
wood, and I just love it. I love all of it. Another thing I love is the outside,
often come and sit over here. The library area, you often see people sitting
when your inside you can feel as though your outside because it’s all there,
round there because that’s gorgeous, but on a sunny day the whole centre is
and vice versa. I love light anyway, so I love the windows here and the way
full of sunlight so everywhere is well used. But everywhere seems to have a
they all open out onto the garden, so in summer when all these doors are
certain place for certain types of visitors.
open it’s like a huge open plan space. And it’s just a great big living area for thousands of people. And people who use this place come back a million
Q: The light throughout the building is amazing. Even today on grey rainy
times; it’s like a great big extended family in a great big extended family
November day it still fills the building.
house.
A: Well the gardens in the summer are always used well because of the way
Q: Do you think there is a different atmosphere when it’s dark and there is
they face South-West, which it was designed specifically to face that way
only artificial lighting?
so it could get all the light and the sun. I’ll show you some of the diagrams (Ted’s drawings) with the big sun showing how important the sun is. So we
A: Yes. I do. It quietens down, the lights soften the mood and people sit
get maximum light at all times, so in the summer people use the outside
more quietly later in the day. Whereas at this time of day (midday) there’s
space in a big way- put chairs out there, sit in the roof gardens, they’ll
light, it buzzes, it’s very lively, there’s lots of people coming through,
have their lunch in the roof garden. We did exercise and yoga in the other
inevitably we get less people through at night-time. There’s mood lighting
garden. We’ll have people from the wards in their wheelchairs and drips up
here so as the day goes on the light softens and so does the mood of the
in the garden with their families and friends. I think the biggest deal in all
place.
of this is the building, is because it also draws the right kind of staff. As I said when I first came in I was thinking Maggie’s wasn’t for me- too touchy feely, too complementary, and I was bowled over when I walked in. And I’ve not ever had any interest in Architecture at all.
66
67
APPENDIX B MAGGIE”S CENTRE BRIEF 1 A brief outline of the general brief given to each architect designing a Maggie’s Centre. The emphasis seems creating a relaxed, home like environment which encourages people to feel natural and relaxed in the space. The Practical Spatial brief: Entrance >Obvious, welcoming, not intimidating the architecture of light
A welcome/ sitting/ information/ library area >From which the rest of the building should be visible >As much light as possible >Views out to grass/ trees/ sky >Be able to see the kitchen area Office space for centre head and fundraiser/ deputy >Accessible from the welcome area >The space should be separate so the welcome area does not seem like an office/ reception. Storage >A video- viewing and computer link information area A kitchen area >Like a ‘country kitchen, with room for a large table to sit twelve’ >Relaxed and inviting enough for anybody to feel welcome to help themselves to coffee or tea. >A central ‘island’ for cooking demonstrations. A large room for relaxation groups/ lectures/ meetings >Large enough to take a maximum of fourteen people lying down >Storage space for relaxation/ folding chairs >Soundproof Two smaller sitting/ counselling rooms for twelve people >With a fireplace and a stove 64 Brief as seen in Kreibrich, 2015.
68
69
>Soundproof Two small rooms for counselling or therapy >Big windows looking out to grass/ trees/ sky Lavatories >Big enough to take a chair and a bookshelf >Private enough to have a cry A very small quiet space to have a rest/ lie down. Outside >Garden areas and ten parking spaces >Continuous flow between house and garden Practicalities: The aim is to run each Maggie’s centre as economically as possible without compromising quality, the restraints on economic factors will be positive in the sense that the aim of the project is to build a modest humane building, which will encourage not intimidate. Overall key aims: 1. As much light as possible
the architecture of light
2. Important to look out and step out
70
3. Minimum administration 4. Scale to be domestic 5. No signs, long corridors that may be confusing 6. Make the building approachable and welcoming 7. Things shouldn’t be too perfect 8. It should feel like a home that people wouldn’t have quite dared build themselves 9. We want the building to make you feel, as Maggie made you feel, more buoyant, more optimistic, that life was more interesting when you left the room than when you walked in. Ambitious but possible.
71
BIBLIOGRAPHY BOOKS Boubekri, M. (2008) Daylighting, Architecture and Health. Amsterdam: Architectural Press. Corbusier, L. (1970) Towards A new architecture. United Kingdom:
the architecture of light
Architectural Press. Chong, Gordon H.; Brandt, Robert; Martin, W. Mike 2010, Design Informed: Driving Innovation with Evidence-Based Design, e-book, http://NCL.eblib. com/patron/FullRecord.aspx?p=624385 [Accessed 10/12/15] Gale, C. J. (1986) Gale on the Law of Easements. 15th edition. London: Sweet & Maxwell. Hamilton, K. and McCuskey Shepley, M. (2010) Design for critical care: An Evidence- Based Approach, 1st edition, Elsevier, Oxford. Heathcote, E. and Jencks, C. (2010) The Architecture of Hope: Maggie’s Cancer Caring Centres. 1st edn. London: Frances Lincoln Publishers. Hobday, R. (2006) The Light Revolution: Health Architecture and the Sun. United Kingdom: Findhorn Press. Lawson, B. and Phiri, M. (2003) The Architectural Healthcare Environment and its effects on Patient Health Outcomes, TSO, Norwich. Nightingale, F. (1863) Notes on Hospitals (Third Edition) Longman, Roberts and Green.
72
73
NHS Estates (1994) Environments for quality care: Health buildings in the
Green Garage (no date) Sustainable window design. Available at: http://
community. United Kingdom: Stationery Office Books.
greengaragedetroit.com/index.php?title=Sustainable_Window_Design (Accessed: 4 January 2016).
Plessis, P. J. du (2010) Borkowski’s textbook on Roman Law. 4th edn. New York: Oxford University Press.
Harvard Health Publications (2012) ‘Blue light has a dark side’ Available at: http://www.health.harvard.edu/staying-healthy/blue-light-has-a-dark-
Purves, G. (2001) Healthy living Centres: A guide to primary health care
side [Accessed: 13 January 2016].
design. Oxford: Architectural Press. Healing (no date) in Oxford Dictionary. Available at: http://www. Shah, M. (2013) Le Corbusier’s Venice hospital project: An investigation into
oxforddictionaries.com/definition/english/healing [Accessed: 10 December
its structural formulation. Farnham, Surrey, England: Ashgate Publishing.
2015].
Sternberg, E. M. (2009) Healing Spaces: The science of place and well-
‘He is the world’s biggest architect, so what took Frank Gehry from Bilbao
being. Cambridge, MA: Belknap Press, Cambridge, Massachusetts, USA.
to a Scottish hillside? The love of a woman’ (2015) Available at: http://
the architecture of light
www.heraldscotland.com/news/12532458.He_is_the_world_apos_s_biggest_ Van den Berg, A. (2004) Health Impacts of Healing Environments, The
architect__so_what_took_Frank_Gehry_from_Bilbao_to_a_Scottish_hillside__
Netherlands.
The_love_of_a_woman/ [Accessed: 8 December 2015].
WEBSITES
Heliotherapy (no date) in Oxford Dictionary. Available at: http://www. oxforddictionaries.com/definition/english/heliotherapy (Accessed: 13
Arehart-Treichel, J. (2005) In treating non-seasonal depression, let
January 2016).
the light shine in. Available at: http://psychnews.psychiatryonline.org/doi/ full/10.1176/pn.40.17.00400014a [Accessed: 24 October 2015].
Lochran, J. (2008) The miracle of Lourdes: A message of healing and hope. Cincinnati, OH: St. Anthony Messenger Press.
Color Puncture Therapy (no date) Available at: http://colorpuncture.org/ [Accessed: 9 December 2015].
Marberry, S. (2010) The inside story: Lessons from IIDA’s healthcare interior winners. Available at: http://www.healthcaredesignmagazine.com/
Daylight benefits in healthcare buildings (2015) Available at: http://
article/conversation-roger-ulrich [Accessed: 27 December 2015].
www.designingbuildings.co.uk/wiki/Daylight_benefits_in_healthcare_ buildings#Daylight_and_pain_relief [Accessed: 13 October 2015].
Myocardium (no date) Available at: http://medical-dictionary. thefreedictionary.com/myocardium (Accessed: 13 January 2016).
Evidence Based Design (no date) Available at: http://ebdjournal.com/ [Accessed: 10 December 2015].
Paimio sanatorium - Paimion kaupunki (2013) Available at: http://www. paimio.fi/en/services/tourism/paimio_sanatorium [Accessed: 12 October 2015].
Fenestration and Window to Wall Ratio (2011) Available at: http://energymodels.com/forum/fenestration-and-window-wall-ratio#comment-9366
Planning clinics for flexibility and adaptability (2015) Available at: http://
[Accessed: 8 December 2015].
www.healthcaredesignmagazine.com/article/seeds-change-interview-rogerulrich?page=2 [Accessed: 8 December 2015].
74
75
Richard Murphy Architects. (1997) Richard Murphy Architects:
Lambert, G., Reid, C.. and Kaye, D. (2002) ‘Effect of sunlight and season
Maggie’s Cancer Caring Centre, Edinburgh. Available at: http://www.
on serotonin turnover in the brain’, The Lancet, 360(9348), pp. 1840–1842.
richardmurphyarchitects.com/viewItem.php/viewItem.php?id=2452 [Accessed: 8
doi: 10.1016/s0140-6736(02)11737-5.
December 2015]. Lee, J. H., O’Keefe, J. H. and Bell, D. (1949) ‘Vitamin D deficiency’, Journal Royal Jubilee hospital patient care centre achieves LEED gold | H.H. Angus &
of the American College of Cardiology, 52(24), pp. 1949–1956. doi: 10.1016/j.
associates Ltd (2016) Available at: http://www.hhangus.com/royal-jubilee-
jacc.2008.08.050.
hospital-patient-care-centre-achieves-leed-gold/ (Accessed: 13 January 2016).
McGuire, L. (2006) Pain and wound healing in surgical patients, Ann Behav Medicine [Apr 31 2006] p.165-72.
Salingaros, N. A. (2013) Fractal art and architecture reduce physiological stress. Available at: https://journalofbiourbanism.files.wordpress.com/2013/09/
Mayo Clinic (2014) ‘Seasonal affective disorder (SAD) definition’, Mayo
jbu-ii-2012-2_nikos-a-salingaros.pdf [Accessed: 29 October 2015].
Clinic.
Treggiden, K. (2013) Maggie’s: Dundee. Available at: http://
Choices, N. (2015) Complementary medicine and the placebo effect
confessionsofadesigngeek.com/maggies-dundee/ [Accessed: 7 January 2016].
- live well - NHS choices. Available at: http://www.nhs.uk/Livewell/ complementary-alternative-medicine/Pages/placebo-effect.aspx (Accessed:
Tuberculosis (TB) definitions (2012) Available at: http://www.niaid.nih.gov/
4 January 2016).
the architecture of light
topics/tuberculosis/Understanding/WhatIsTB/Pages/TBdefinitions.aspx [Accessed: 24 November 2015].
ARTICLES/ JOURNALS/ RESEARCH PAPERS Benedetti, F., Colloca, L. and Torre, E. (2004) ‘Placebo-responsive Parkinson patients show decreased activity in single neurons of subthalamic nucleus’, Nature Neuroscience, 7(6), p. 587–588. doi: 10.1038/nn1250. Chepesiuk, R. (2009) ‘Missing the dark: Health effects of light pollution’, 117(1). Johnson, B. (2012) ‘Healthcare quarterly, Vol. 15 special issue | excellent care for all’, Healthcare Quarterly, 15(Special Issue). Knapen, S. E. (2014) ‘The duration of light treatment and therapy outcome in seasonal affective disorder’, Journal of Affective Disorders, 166, pp. 343–346. doi: 10.1016/j.jad.2014.05.034. Kreibich, W. (2015) ‘Can Architecture Make You Feel Better?’ Sheffield University.
76
Rajimehr, R., Devaney, K. J. and Bilenko, N. Y. (2011) ‘The “Parahippocampal place Area” responds preferentially to high spatial frequencies in humans and monkeys’, PLoS Biology, 9(4), p. e1000608. doi: 10.1371/journal.pbio.1000608. Ryan, R. M., Weinstein, N. and Bernstein, J. (2010) ‘Vitalizing effects of being outdoors and in nature’, Journal of Environmental Psychology, 30(2), pp. 159–168. doi: 10.1016/j.jenvp.2009.10.009. Schweitzer, M, Gilpin, L & Frampton, S. (2004) Healing Spaces: Elements of Environmental Design That Make an Impact on Health, Journal of Alternative and Complementary Medicine, Vol. 10. p. 49. Ulrich, R. (1984) ‘View through a window may influence recovery from surgery’, Science, 224(4647), pp. 420–421. doi: 10.1126/science.6143402. Ulrich, R. (1999). Effects of gardens on health outcomes: theory and research. Chapter in C. Mar-cus and M. Barnes (Eds.), Healing Gardens: Therapeutic Benefits and Design Recommendations. New York: John Wiley. p.49.
77
Wang, P., Ren, F.-M. and Lin, Y. (2015) ‘Night-shift work, sleep duration, daytime napping, and breast cancer risk’, Sleep Medicine, p. 462–468. doi: 10.1016/j.sleep.2014.11.017. Wallis, D. E., Penckofer, S. and Sizemore, G. W. (2008) ‘The “Sunshine Deficit” and cardiovascular disease’, Circulation, 118(14), pp. 1476–1485. doi: 10.1161/CIRCULATIONAHA.107.713339.
VIDEO Weller, R. (2013) Ted Talk: Could the sun be good for your heart? Available at: https://www.ted.com/talks/richard_weller_could_the_sun_be_good_for_
the architecture of light
your_heart?language=en [Accessed: 16 January 2016]
78
79