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‘Therapeutic landscapes’ and the importance of nostalgia, solastalgia, salvage and abandonment for psychiatric hospital design

Originally Published:
2015
Key Point Summary
Key Point Summary Author(s):
Dickey, Andrew
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Key Concepts/Context

There is a growing body of research exploring the concept of the “therapeutic landscape” or how the social, material, and symbolic characteristics of a given environment might positively affect one’s health. Studies show that many aspects of the physical environment can invoke positive or negative feelings, especially if there are features of the environment that are somehow related to one’s own memory. This idea presents a new avenue of options for designers working in psychiatric healthcare spaces, especially in cases where long-term psychiatric patients are moving to a new facility. Patients may have a positive or negative association with certain aspects of the old and new designs. Further research into those associations could help determine which design decisions are most effective.
 

Objectives

To explore psychiatric patients’ emotional reactions to medical spaces which were redesigned to evoke past experiences.
 

Methods

Physical features and floor plans of the old hospital were compared with those of the new hospital design before the researchers conducted semi-structured interviews and group discussions. The group of 127 interview participants included patients, healthcare providers, and other hospital staff members. Interviews began with the question: “Which features of the old or new hospital are good or not good for well-being?” The results from the wide-ranging discussions were then analyzed and compared with the “therapeutic landscape” concept.
 

Design Implications
The authors note that designers should consider how “history matters” when renovating older facilities or when completely rebuilding a facility. Patients and staff may draw important emotional connections to certain features, particularly those that provide a sense of community and individual expression. Designers might consider interviewing staff and patients prior to planning and construction about which features they value.  
Findings

Some staff members felt nostalgic for the old building due to the sense of community its design fostered via fewer private rooms and the presence of a recreational hall. The “homely” design of the older hospital, or its overall “character” also inspired nostalgia in all study participants. Feelings of solastalgia, or distress over changes in the physical environment, were more prevalent in the newer building, which was described as “clinical” and lacking a community feel. However, other participants were eager to leave the old hospital and found the newer facility far more comfortable and efficient. The authors note that these results highlight how the “therapeutic landscape” is a disputed concept and that emotional perceptions can differ widely in the contexts of nostalgia and solastalgia.
 

Limitations

This study focuses on the subjective emotional reactions of patients and staff following a single hospital’s transition from an old design to a newer one; given the relatively small sample size of interviewees and the unique nature of the hospital in question (both in terms of appearance and history), these results may not be applicable to most hospitals undergoing transition.
 

Key Point Summary Author(s):
Dickey, Andrew
Primary Author
Wood, V. J.