The Pulse, Buildings, and the Therapeutics of Design

Maiken Scott hosts the excellent “The Pulse” on WHYY here in Philadelphia. Each episode explores “stories about the people and places at the heart of health and science.” Or, put another way, each week she spends a delightfully informative hour examining some constellation of issues where health and science interact with and inform (or could inform) how society understands a particular question. One show this past August looked at buildings—their design, their size and location, the materials—to get a better sense of how architecture and interior spaces affect our lives: How Buildings Impact Our Lives.

“How Buildings Impact Our Lives” on WHYY’s The Pulse.

The show opens with Maiken and a couple guests reflecting on the experience of a hospital. They refer to the incessant “sounds of illness” and the absence of “fresh air.” The first guest, who had recently spent considerable time visiting relatives in a hospital observed that the “light was so fake” and how upon leaving the hospital she was overcome by the “immediate feeling of fresh air or sunlight on [her] skin … reminded [her] that [she] was alive.” The second guest, Erin Nunes Cooper, was an architect with the firm Ballinger who specializes in health care design, noted:

When I think of hospital in a stereotypical way I think of a big patient ward or a building that is just kind of a nondescript block.

But it doesn’t have to be that way, she added:

So a current or modern hospital when we see that identity really kinda from the exterior should send a message that it’s a welcoming place and it’s a place to kinda heal rather than a place to just be sick. … How do we say that in “architect?” Uh a lot of it is said in the design that we come up and the materiality that we choose and the scale and in the texture. And having this idea that a building can be made of materials that are calming or that have a texture that people can relate either to their home or to nature, to something that’s a little more familiar than what might be an intimidating machine of a hospital. … We love glass. We love light. We love bringing light in. And it actually helps people just have a connection to the outside as a patient if you’re recovering or healing in a patient room.

She points out that today she and like-minded colleagues increasingly focus on design and materiality and texture that can be related to the home or nature. In other words, the physical design of the hospital from the choice of materials and how they look and feel to the layout of the building has become therapeutic.

While the whole episode is worth your time (there’s a great segment on building materials and another on heating with steam), I want to focus just on these opening concerns. That is, the role of space, building materials, light, air, the ideals of home and nature, and even sound as therapeutics.

“Modern” hospitals and today’s architects are not the first to realize the therapeutic importance of design, materials, and space. Two centuries ago and about 7 miles north of Ballinger’s offices in downtown Philadelphia, local Quakers were designing a brand new, “modern” hospital for mentally ill patients: “The Asylum for the Relief of Persons Deprived of the Use of Their Reason.”

View of the Asylum from annual report for 1820, State of the Asylum for the Relief of Persons Deprived of the Use of Their Reason (1820)

Philadelphia Quakers were motivated by concerns and issues that would seem all too familiar to today’s architects. They noted the cavernous patient wards the nondescript, often prison-like buildings that housed patients. They worried about the effects of iron bars and other forms of restraint on patient health and possibility of recovery. They lamented the dark and dank interiors. They focused the design and aesthetics of the exterior and interior spaces, on the availability of natural light and air, on the materials used to construct the asylum. They even worried that the sounds created by the materials used to house patients. So the Quakers organized committees, collected donations, purchased land, and designed and built a new type of asylum. Their goal was clear:

The asylum should be domestic rather than punitive and should embody “not the idea of a prison, but rather that of a large rural farm” while ensuring safety and security for all members of the family.

In 1813, early in the process, the Building Committee for the Friends’ Asylum created a subcommittee to address some of these concerns: The Subcommittee on the Admission of Light and Air. At first the committee was charged with the design and placement of the exterior windows. Later, the committee’s purview expanded to include the design and construction of interior windows and even the locks on patients doors, which too often made a “harsh and ungrateful sound.” The committee designed a special double sash system that they could fabricate out of iron but would look like a standard wood sash. More importantly, the windows could be opened or closed by the patients to allow airflow but guarantee patient safety. At one point, to ensure that the windows would allow sufficient admission of light and air, the Subcommittee on the Admission of Light and Air recommended (and the Building Committee approved) redesigning the entire front of the building, despite the considerable cost:

The unavoidable extension of the front, arises from the necessity of affording comfort and convenience to the patients, by procuring a free admission of light and air. This important consideration will lead, in the first instances, to more expense, but we do not doubt will be fully counterbalanced by the advantages resulting from it.

A year or so later the Subcommittee formed for a sub-subcommittee to design locks for the patients’ rooms. They tackled this aspect of their work with equal enthusiasm and diligence. They worked closely with the U.S. Patent Office and local locksmiths to design and fabricate a lock that was both visually and acoustically pleasing and secure. In both the case of the locks and the window sashes, Philadelphia Quakers through their understanding of insanity reimagined and transformed iron, a traditional asylum building material, from a punitive to a restorative material.

What linked window sashes to door locks was a Quaker understanding of “insanity” as caused by socio-environmental conditions. Treating persons seen to be insane, thus, depended on creating and maintaining restorative socio-environmental conditions. For Philadelphia Quakers such restorative conditions were produced in the combination of domestic aesthetics and ideals of security for both the insane and for their caretakers. The Quaker domestic aesthetics were secure and asylum security was aesthetic. When designing and fabricating window sashes and door locks, the Philadelphia Quakers transformed iron, a traditional asylum building material, by deploying it in new forms in service to their desire to construct a pleasing and secure asylum. Their recognition that window sashes and door locks were problems to be solved and their sustained efforts to design, evaluate, and fabricate material solutions, to comprehend both problems and solutions as ethical, aesthetic, technical and even tactile challenges, derived from of their understanding of insanity and evinced their new ethos of care.

The window sashes and door locks are just two of the many ways early–19th-century Quakers had identified the therapeutic importance of the materials, the design, the construction, of light and air, and even aesthetics. That architects today are echoing those long-dead Quakers’ concerns prompts me to think once again that we would all benefit from a little more history.

To read more on the development of window sashes, locks, and the Quaker ethos of care, see “The Inmate’s Window: Iron, Innovation, and the Secure Asylum” in the forthcoming volume New Materials: Towards a History of Consistency (Lever Press, [probably April] 2020). If you can’t wait until April, send me a note.

New Materials: Towards a History of Consistency (Lever Press, 2020), edited by Amy E. Slaton

Note: You will be able to read this entire volume (and all volumes published by Lever Press) online for free, forever. You can print out chapters or the entire thing, for free, forever. If you want a printed copy, you can order one for a reasonable price. See Lever Press for other published and forthcoming books.

The Quakers & Mental Health portal, hosted at Haverford College.

If you want to know more about the Friends’ Asylum, you can start at this wonderful online resource: Quakers and Mental Health. You can also peruse some of my other posts on the Friends’ Asylum.