Therapeutic Gardens: Nature as Remedy in Hospitals
For the Cosmos Foundation, environmental conscience, ecological conservation, and community focus form the foundations of land planning and landscape design within public infrastructure projects. We sat down with the foundation’s project director, Felipe Correa, as well as foundation architects Valentina Schmidt and Consuelo Roldán, as they went in depth on the benefits, objectives, and motivations behind the Healing Gardens initiative.
Nature’s Place Within Hospital Infrastructure
Throughout the conquest and colonial times, plants held a central place within hospital architecture, especially within sanatoriums specializing in the treatment of tuberculosis and mental illnesses. As time passed, however, natural spaces disappeared from medical buildings in Chile and the rest of the world, thanks in part to the Hygienist Movement of the 19th and 20th centuries. For the past few decades, however, scientific research has mounted evidence against the Hygienist methods in support of re-incorporating nature into healthcare, since, “in many cases, gardens and nature are more powerful than any medicine” (Sacks, 2019). This research could–and should–revolutionize hospital architecture through a new understanding of how the human body works and its connection with its surroundings.
Healing Gardens: A Way of Incorporating Nature into Health Centers
While nature heavily influenced early hospital architecture, it’s therapeutic potential has largely been ignored within modern medical paradigms, due largely to sanitation policies and budget restrictions. Nevertheless, throughout the 80s, various studies were done that demonstrated the necessity of reincorporating natural elements into hospitals.
The wide range of scientific studies as well as the empirical evidence gathered in hospitals indicate that reincorporating natural elements into hospitals will prove to be a monumental task. Given the amount of perspectives supporting their therapeutic potential, Healing Gardens offer a solution. The initiative aims to integrate Healing Gardens into healthcare systems via public policy, setting the foundations for reconnecting humans with the environment.
The Healing Garden offers a natural space within a healthcare facility for patients, family, and hospital staff. Its design aims to bring the benefits of the outdoors into the hospital, adding to the physical, psychological, emotional, and social elements of wellbeing and maximizing patients’ recovery. (Jardines Sanadores, 2019).
In the same way that medicine understands the human body as a unit that doesn’t focus on a singular organ to heal the entire individual, it should also understand that the individual and their recovery process is connected to their environment. In keeping with this understanding, reestablishing nature’s place within the healthcare system is essential to changing the overall paradigm and much of this transformation starts with the infrastructure and architecture of health facilities.
Three Points to Consider in the Development of Healing Gardens
Through the ten experimental Healing Gardens placed in hospitals throughout Chile, the Cosmos Foundation has pinpointed three essential elements when planning for future spaces in other healthcare facilities.
Nature’s place within spaces for healing and recovery
In Roger Ulrich’s 2002 paper titled the Health Benefits of Gardens in Hospitals, Ulrich highlights the connection between aesthetics and emotions and how garden design can create spaces that enhance a human being’s connection to nature and thus optimize their recovery and overall health.
The aforementioned study took place in the Healing Garden and Memorial of the Maritime Sanatorium of Viña del Mar, in the Valparaíso Region of Chile, and looked to study the benefits of the garden for both the patients, mainly children with severe neurological injuries, and the staff at the facility. Nestled in a gorge with sweeping ocean views, the 1.300m2 site provides an ideal space to relax and connect with the surrounding nature. Taking into consideration the conditions of the patients and the layout of the space, the project participants determined that the existing fruit trees would provide optimal sensory treatments and then designed three work spaces within the garden all connected by a walking trail, allowing visitors to experience an array of colors, smells, and textures during their time in the space.
The garden features an area with pomegranate and lavender plants with for hands-on exploration and a space for workshops and horticultural therapy, where participants can participate in the sewing and harvesting of plants and witness actively witness their lifecycle. This not only provides an educational experience for the young patients, but allows them to develop their motor and sensory skills as well.
The last area within the garden provides a space dedicated to emotional healing, an ever-growing need for the surrounding community. The space is lined with thickets of verbena, pepper trees, and soapbark, which separate it from the main area of the garden. Birdhouses were installed to attract birds to space, allowing visitors to enjoy birdsong as a part of their experience within the garden.
Incorporating natural spaces into hospital infrastructure will facilitate effective, sensory-based therapeutic practices proven to benefit the human mind and body. More importantly, current national trends make it more possible than ever to incorporate this spaces into the national health system.
Nature as Patrimonial, Communitarian, and Healing Infrastructure
Findings by Vidal and Pol (2005) regarding environmental psychology indicate that an important element of feeling part of a social group is feeling connected to physical spaces significant to said group. The Cosmos’ Foundations builds on this concept in their research on rehabilitation within healthcare communities that highlight the importance of empowering individuals through exposure to the native ecosystem.
A clear example of this is the Jacaranda Healing Garden at the Children’s Neuro-Psychiatric Service of the San Borja Arriarán Hospital in Santiago, which treats more than 30,000 patients annually. This 1,600m2 space houses the original trees from the hospital’s old garden, including six Phoenix palms that precede the building’s construction. For the surrounding community, these trees became a part of the local collective subconscious, denoting not only the history and heritage of the building but of the community itself and the experiences lived by its members within the hospital. This made the palm trees a focal point for the creation and layout of the healing garden and they served as the markers for the distinct areas within the garden, such as the spaces for meditation, sensory activities, physical therapy, and workshops.
In the case of gardens within historical hospitals, plants often harbor a connection with the local community and the incorporation of local flora into landscape and architectural project should focus more on plants’ place within local health customs than on their aesthetic qualities.
Nature in Hospital Infrastructure
There is evidence that some elements of exterior design have significant impact on the clinical results of patients (Rubin, 1998).
Another such garden can be found at Pequeño Cottolengo, an institution located in the Cerrillos Commune of Santiago that specializes in the care of mentally disabled individuals. Many of its residents have limited mobility and can’t independently visit the green spaces on the institute’s grounds so, to give them access to a nature area, the garden was designed without divisions or barriers between spaces. The space consists of two gardens connected by a sheltered terrace that allows residents to enjoy the garden even when it’s cold or raining. This also allows patients who can’t go outdoors to visually enjoy garden within a space that can accommodate their needs.
A great deal of research has indicated that people who feel in control of their circumstances demonstrate higher stress management and better overall health than individuals who feel they have little power over what happens to them (Evans y Cohen, 1987). This perceived loss of control yields negative results within treatment, especially when patients perceive they have no ability to decide where they go, what they do, and are placed under constant supervision with no time to themselves to relax or pursue their own interests (Taylor, 1979; Ulrich, 1991, 1999). Healing gardens aim to alleviate this restrictive environment by breaking up the monotonous routines of the patients, giving them the freedom to move about and explore in a safe, private, and relaxing space.
Other research has shown that, in many cases, people who have greater social support experience less stress and better health than those who face isolation and fewer social connections (Shumaker y Czajkowski, 1994). At Cottolengo, this support is provided by the staff, whose needs were also considered in the project’s design. These considerations led to the creation of a relaxation space, where the staff can interact with each other and build their support systems (Marcus y Barnes, 1999). The staff’s space includes shaded benches surrounding a fountain, offering both scenic and auditory relaxation experiences to give them a respite from the hustle and bustle of the workday.
In this context, vegetation serves as a design element able to transform otherwise inhospitable areas into comfortable, relaxing environments that benefit everyone, including those suffering from both physical and mental ailments.
Looking Forward: Nature within Hospital Infrastructure
Not only do plants aid in stress and pain reduction, but they also add to sleep quality and decrease the likelihood of reinfection, resulting in both decreased hospitalization times and costs (Ulrich: 1990). For these and many other reasons, nature within hospital infrastructure should become a fixture in all areas of the national health system.
Firstly, it has been demonstrated that it is necessary to bring hospitality back to hospitals; in other words, return to the origins of health-centered architecture and incorporate research-based natural elements into our health infrastructure. This starts with a cultural shift in both how we design and build hospitals and how we plan and apply therapies, implying a trans-disciplinary approach applied across both the architectural and medical field.
Secondly, this cultural shift should be bolstered by public policies based on current scientific evidence. This means that changes are not limited to only the nation’s prestigious medical institutions but are made available to any and all who desire or require them. Conversely, if government entities disagree with said evidence, this will not only result in monetary losses but the potential loss of life. Luckily, the implementation of nature into Chile’s hospitals is effectively possible.
In the midst of the COVID-19 pandemic, these changes are more needed than ever. In times of epidemics and pandemics, humans have aligned with and distanced themselves from nature on a cyclical basis. The question is, where are we in the cycle currently? Will designers and healthcare professionals be able to advocate the scientific evidence and overturn existing cultural notions that hold back health and healing? Given this historic and complex time we are living in, the answer remains unclear but the opportunities are bright. In the words of Alexander von Humboldt, “in this great chain of causes and effects, no single fact can be considered in isolation” (Humboldt, 1807:43). In essence, nature is a living ensemble within which all organisms are intertwined in a network driven by dynamic change: the cosmos. (Wulf, 2015:293-308)
Now has never been a more opportune moment for hospital architecture to shift and realign itself with its naturalistic roots and incorporate nature into its design, resulting in a holistic and healing approach to modern healthcare.
About the authors:
Felipe Correa Tagle
Architect, Pontifical Catholic University of Chile, 2005. Publications include “Planificación de la Precordillera como Plataforma para la expansión de los Parques Urbanos: el caso del Parque Natural Cantalao Precordillera” (published in From The South/Desde el Sur: Global Perspectives on Landscaping and Terrain, Sciaraffia et al, Chile, 2019). He has been a professor of Architecture at the University for Development. Since 2014 he’s been the Project Director for the Cosmos Foundation in Chile.
Valentina Schmidt Escobar
Architect, University of Chile, 2011. Fullbright and CONICYT Scholar for Master in Urban Design, University of California Berkeley, USA, 2017. Her publications include San Francisco Bay: Adaptation by Design, jointly published by the University of California Berkeley and the Architecture School at Delft University of Technology, 2016-2017, She is the co-author of the book Ephemeral Urbanism: The Landscape of Temporary Cities, Harvard Graduate School of Design, 2015-in the process. She has been an assistant professor of Architecture and Urbanism at the University of Chile. Currently, she serves on the architectural team of the Cosmos Foundation.
Consuelo Roldán Diethelm
Architect, Masters of Landscape Architecture from the Pontifical Catholic University of Chile, 2017. Masters Thesis presented at the 10th Landscaping Biennale in Barcelona, 2018. Roldán is a professor of City and Landscaping at the University for Development in Chile and has been an instructor for the Masters in Terrain and Landscaping at the Diego Portales University in Chile as well. She is part of the architectural team for the Cosmos Foundation.