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Lost in space The place of the architectural milieu in the aetiology and treatment of schizophrenia
Abstract
Purpose – Psychological and epidemiological literature suggests that the built environment plays both causal and therapeutic roles in schizophrenia, but what are the implications for designers? The purpose of this paper is to focus on the role the built environment plays in psycho-environmental dynamics, in order that negative effects can be avoided and beneficial effects emphasised in architectural design. Design/methodology/approach – The approach taken is a translational exploration of the dynamics between the built environment and psychotic illness, using primary research from disciplines as diverse as epidemiology, neurology and psychology. Findings – The built environment is conceived as being both an agonist and as an antagonist for the underlying processes that present as psychosis. The built environment is implicated through several means, through the opportunities it provides. These may be physical, narrative, emotional, hedonic or personal. Some opportunities may be negative, and others positive. The built environment is also an important source of unexpected aesthetic stimulation, yet in psychotic illnesses, aesthetic sensibilities characteristically suffer from deterioration. Research limitations/implications – The findings presented are based on research that is largely translated from very different fields of enquiry. Whilst findings are cogent and logical, much of the support is correlational rather than empirical. Social implications – The WHO claims that schizophrenia destroys 24 million lives worldwide, with an exponential effect on human and financial capital. Because evidence implicates the built environment, architectural and urban designers may have a role to play in reducing the human costs wrought by the illness. Originality/value – Never before has architecture been so explicitly implicated as a cause of mental illness. This paper was presented to the Symposium of Mental Health Facility Design, and is essential reading for anyone involved in designing for improved mental health.
... Topp, Moran, & Andrews, 2007). Contemporary asylum design, albeit less frequently researched, has also been discussed by geographers and architects on the basis of post-occupancy evaluations (Curtis, Gesler, Fabian, Francis, & Priebe, 2007;Gesler, Belle, Curtis, Hubbard, & Francis, 2004) and to support new models of design (Golembiewski, 2012(Golembiewski, , 2013. Aspects such as the integration of the facility in the community and the role of elements conveying a sense of home and security have been highlighted by the former, while the latter insist on the provision of positive affordances and on the importance of designing spaces that are specific to different groups of psychotic patients depending on their type of diagnosis. ...
... "In Ouchy, it's easy to meet people, perhaps because people are more relaxed" (man, 19 years) But, there should not be too many acquaintances in these places: the feeling of being under the surveillance and judgement of others (Parr, Philo, & Burns, 2004, p. 406). Turned into positive terms, places providing patients with 'positive affordances' (Golembiewski, 2013) are charaterised by what I would call a 'familiar anonymity'. Together with material features, like readability, these opportunities for chosen social interaction create what some of our interviewees called the 'feel' of a place. ...
... Care, as I have shown in my discussion of geographical studies of mental health, should be designed at the scale of patients' spatial practices. The development of a user-assisted design of mental healthcare facilities sensitive to the diversity of pathologies and needs (Golembiewski, 2013) is to be welcomed. But design should more broadly aim to create a landscape of care, articulating different places and spaces in order to make cities' resources available to persons suffering from psychotic troubles but also to protect them from highly stress-generating milieus. ...
... Je souligne à cet effet que la spatialité du rétablissement, c'est-à-dire le rapport entre les pratiques des individus et les diverses « prises » offertes par un environnement donné (Golembiewski, 2013), s'élargit progressivement vers de nouveaux espaces urbains aux ressources multiples et variées 4 . Les « prises » renvoient à des ressources matérielles, sociales et sensorielles mobilisées par les jeunes gens au cours de leur rétablissement (Golembiewski, 2013). Dans cette perspective, la spatialité du rétablissement est à la fois façonnée à travers les pratiques des individus et déterminée par la réalité matérielle de l'espace. ...
... Chez certaines personnes les symptômes disparaissent progressivement au fil du temps, alors que chez d'autres ils réapparaissent à nouveau avec une intensité généralement plus forte. 4 Golembiewski emploie le terme de « positive affordance » pour désigner les ressources de l'environnement (Golembiewski, 2013). J'ai choisi de traduire ce terme par « prise » permettant de souligner la dimension à la fois produite et vécue de l'espace urbain par des acteurs. ...
... Cet article cherche à élargir le champ de recherche en géographie, en proposant une réflexion sur les pratiques urbaines de jeunes personnes souffrant de schizophrénie après un premier épisode psychotique 5 , dans un contexte suisse qui fait pour l'instant l'objet de peu d'études. Les travaux actuels en géographie de la santé mentale s'attachent en effet essentiellement à décrire les pratiques de jeunes personnes psychotiques dans des contextes américains, australiens, néo-zélandais, allemands et britanniques (Parr, 2006(Parr, , 2008Philo et Wolch, 2001 ;Knowles, 2000 ;Estroff, 1985 ;Gleeson, 1999). De même, les temporalités dans lesquelles s'ancrent ces pratiques ne sont que partiellement analysées, bien qu'elles influencent de façon déterminante les trajectoires spatiales de rétablissement des jeunes personnes souffrant de schizophrénie. ...
The article aims to provide a better understanding of the urban practices of
young people living with a diagnosis of psychosis while recovering. I show
the way practices are adjusted according to the temporal dynamics of
psychosis. I argue that the continuous variability of symptoms over the
recovery period implies alternately practices of withdrawal and reconquest of
the urban space. I first outline participants' reconquest of urban spaces,
which starts in well-known places and then extends to less familiar ones. In
doing so, I point out the diversity of urban spaces inhabited by participants
during the recovery process which includes institutional, private, as well as
public places. I then outline the various material, relational and sensory
resources available in these spaces. I show how participants use them
according to the temporal dynamics. I finally highlight the way participants
are gradually getting involved in the relationship with a large array of
resources as the intensity of symptoms is reducing. My analysis is based on a
three months ethnography in a therapeutic institution in Lausanne.
... 5 Although we tend to spend considerable time considering superficial aspects of design like colours and sounds, these "raw sense data" do not provide the more important opportunities that the actual building design can provide: involvement with aspects that are recognizable, and able to be manipulated and used. 6 The commonly used alternative of television watching used frequently in rehabilitation units defines a diminished environment if there are no other activities offered. ...
... Parallel to research exploring opportunities for increased physical activity within general rehabilitation environments, there is now emerging work investigating methods of affecting psycho-social aspects. 6 The built environment can play a role in psycho-environmental dynamics and reflects on research that has shown the environment to have a significant effect on the psychogenesis of mental illness. 6 As psycho-social aspects of recovery after general rehabilitation are also important, it seems vital to consider these findings in this additional context. ...
... 6 The built environment can play a role in psycho-environmental dynamics and reflects on research that has shown the environment to have a significant effect on the psychogenesis of mental illness. 6 As psycho-social aspects of recovery after general rehabilitation are also important, it seems vital to consider these findings in this additional context. Participants in this current study were able to suggest many affordances to improve their feelings of well-being, and most of these suggestions related to issues aside from their formal therapy sessions. ...
Background
Design of rehabilitation environments is usually “expert” driven with little consideration given to the perceptions of service users, especially patients and informal carers. There is a need to engage with consumers of services to gain their insights into what design aspects are required to facilitate optimum physical activity, social interaction and psychological responses when they are attempting to overcome their limitations and regain function.
Research design
Qualitative exploratory study.
Method
Interviews were conducted with patients (n = 54) and informal carers (n = 23), and focus groups with rehabilitation staff (n = 90), from the three metropolitan South Australia rehabilitation health services, comprising different building and environmental configurations. Thematic analysis was assisted by the use of NVivo 11 qualitative software, with pooled data from all interviews and focus groups undergoing open, axial and finally selective coding.
Results
Four major themes were identified as follows: (a) choice can be an Illusion in a rehabilitation ward; (b) access to outside areas is a priority and affects well‐being; (c) socialization can be facilitated by the environment; and (d) ward configuration should align with the model of care.
Discussion and Conclusion
Participants who encountered the most restrictive environments accepted their situation until probed to consider alternatives; those who enjoyed the most choice and access to facilities showed the greatest enthusiasm for these affordances. Future architectural designers should therefore consider the perceptions of a wide range of consumers with varying experiences to ensure they understand the complex requirements of patients and that the ward design facilitates the optimum rehabilitation model of care.
... This attentional focus on the staff station contributes to the 'honeypot syndrome,' where patients loiter around the staff stations ( Figure 1 shows a typical staff-centred facility). While the staff station is widely understood to be a non-negotiable requirement of a mental health facility, the only evidence on the subject builds a compelling case against the implementation of staff stations altogether -because when staff stations are removed or made more democratic (by removing glazing), the behaviour in the facility radically improves for both clients and staff (Golembiewski, 2013;Tyson et al., 2002) (see Figure 2). ...
... But it's not only behaviour that's affected. Bad environments appear to have a powerful causal influence in mental illnesses (Golembiewski, 2013). Effectively, mental health facilities are the 'wrong vehicles' for the job at hand, and they must change along with treatment and management protocols. ...
... passive nor minor. Indeed, several studies suggest that it's perhaps the largest and most consistent factor contributing to psychotic illnesses (Golembiewski, 2013). The psychotropic potency of the environment was also unequivocally demonstrated by Ellett et al. (2008), who exposed 30 paranoid psychotic patients and matched controls to a 'dose' of only 10 min of walking through a relatively normal, albeit slightly rundown urban environment. ...
There is a schism between a growing chorus for person-centred models of care and the prevalent paradigms for the design of mental health facilities. This argument proposes that architectural solutions have traditionally been geared around staff-centred concerns like ease of patient management. It suggests that the demands for person-centred models of care are important because evidence suggests that the physical environment is a causal factor in mental illness, and that even minor concessions towards person-centred models of care consistently exert a disproportionate and sustained positive influence on the behaviour of mental health patients.
While the traditional mental health unit layout is unsatisfactory for person-centred care and effective recovery, other approaches that have been well tested and found to be effective is described along with a statement about subtle details that will improve facilities for all users.
... They have made extraordinary associations between the mental illness sector of mental health, and urban development, including replicating epidemiological data (Kelly et al. 2010;van Os et al. 2010), and even tied these findings to specific neurological morphologies (Haddad et al. 2014;Lederbogen et al. 2011;Lederbogen et al. 2013). Attempts to draw the science of public/mental health and urban design is still rare according to the found literature, although it has been done, leading in some cases to practical recommendations for architects and urban designers to put mental health factors into consideration during the design process (Golembiewski 2012(Golembiewski , 2013(Golembiewski , 2016. ...
... While many studies have confirmed that exposure of individuals to natural environmentsincluding blue and green spacescan boost stress reduction and assist in mental recovery (Golembiewski 2012(Golembiewski , 2013(Golembiewski , 2016Depledge et al. 2011), there are still very few studies that address features of the designed environment that may either trigger mental illness or protect against it (Golembiewski 2016). This area of the urban design/mental health relationship can be particularly important in the post-war urban design, as a high percentage of people most probably suffer from various mental illnesses. ...
The review firstly explores the relationship between mental health and urban design, pursuing the role of urban design in both health promotion and illness prevention against the mental illness epidemics, by conducting a comprehensive literature search; secondly, a systematic literature search is conducted to explore the relationship between urban design and post-traumatic stress disorder (PTSD) specifically. Apparently, health in general and urban design do share a solid history, however, even though mental health/urban design relationship has been increasing over the past 20, they seem to share a weak historical relationship, and even recent research that tries to define links between the two is still preliminary. On the other hand, a gab in knowledge can be addressed regarding the relationship between PTSD and urban design.
... Environmental conditions positively affect health outcomes and are especially important in residential facilities, where patients stay for extended periods of time. Because the built environment is an "important domain for self-discovery and therefore for the establishment of a sense of self" (Golembiewski, 2013), the design of environments to support improved health outcomes for specific patient groups in mental health facilities requires that patient needs and patient-staff relationships are at the center of the decision making. A patient-centered approach is critical when planning specialized psychiatric facilities as each serves a distinct population requiring unique design considerations. ...
... A wayfinding system is an integrated system of coordinated elements, including visible and easy to understand signs, color coding and numbers, clear and consistent verbal directions, consistent written and electronic information, and a legible physical setting (Carpman and Grant, 1993). Golembiewski (2013) suggests, "For best effect, space[s] should be logical, non-repetitive and well marked with measurable objects and function" (p. 15). ...
... Environmental conditions positively affect health outcomes and are especially important in residential facilities, where patients stay for extended periods of time. Because the built environment is an "important domain for self-discovery and therefore for the establishment of a sense of self" (Golembiewski, 2013), the design of environments to support improved health outcomes for specific patient groups in mental health facilities requires that patient needs and patient-staff relationships are at the center of the decision making. A patient-centered approach is critical when planning specialized psychiatric facilities as each serves a distinct population requiring unique design considerations. ...
... A wayfinding system is an integrated system of coordinated elements, including visible and easy to understand signs, color coding and numbers, clear and consistent verbal directions, consistent written and electronic information, and a legible physical setting (Carpman and Grant, 1993). Golembiewski (2013) suggests, "For best effect, space[s] should be logical, non-repetitive and well marked with measurable objects and function" (p. 15). ...
... 8 Moreover, by bringing the terms carceral and design together, I suggest that they delineate a field that positions carceral design as a distinct field of design research. To my knowledge, scholars of design and other fields have not used the term carceral design explicitly, but they have clearly expressed, for example, how the distribution of space and materiality is rooted in a penal ideology and carceral heritage (Allen, 2020;Foucault, 1991;Fransson, 2018;Goffman, 1961;Golembiewski, 2013;Hammerlin, 2015;Jewkes, 2017;Moran, 2015;Osmond, 1957;Sommer, 1976;Wener, 2012). Hammerlin asks, "What does it mean for a person to be in prison and the prison to be in the person?" ...
With increasing global and local incarceration, the demand for prison beds is rapidly growing. The Swedish government’s plans for implementing youth prisons and amending laws regarding young people’s sentences risk increasing the already high numbers of mental health problems. Although security is an inherent element of institutions for care and incarceration (ICI), the present focus on reinforcing security is similarly jeopardizing the health of inmates, patients, and youths in prisons, forensic psychiatric hospitals, and youth homes. Moreover, the rapid production of beds will likely lead to issues with staff security and work environment.
The field of research for design in correctional institutions and behavioral health is limited. Although there is an increased interest in evidence-based design, EBD cannot be said to extend to all design aspects for vulnerable people in ICIs. However, this dissertation critically discusses the dichotomies, meanings, and connecting lines between incarcerated humans, the interior, and stuff, and it looks primarily at the design of institutions in Scandinavia. Moreover, ICIs are understood in this dissertation as an existential and ethical dichotomy with well-being on the one hand and the losses that incarceration brings on the other. The tension between punishment and (re)habilitation manifests through materiality, design, and high-security measures. However, the question for design is not whether it is possible to hinder the pain and losses that come with incarceration but how design can mitigate these losses, alleviate pain, foster well-being, and assist staff through a safe and supportive work environment.
Part of this doctoral project has been conducted within a multidisciplinary research project aimed at creating knowledge about youths’ experience of the physical environment in Sweden’s youth homes (SiS). Two of this dissertation’s five papers were written as part of this research project (IV, V). The other three papers discuss the early method development of Sketch and Talk (II), the narrative of patients’ experience of the physical environment in forensic care (I), and the design of prison cells through the narratives of three women (III).
The theoretical underpinning of this dissertation is inspired by phenomenology and ethnography. It therefore advocates for a design research methodology that brings the researcher closer to the phenomenon and into the node of peoples’ experiences. Hence, one of this dissertation’s contributions is the Sketch and Talk method, which uses sketching and talking when meeting a participant in their cell or room as a way of creating a space for mutual observation and understanding of the interior. Moreover, as ethical awareness is paramount in research with vulnerable groups, the method has been valuable through its transparency and open approach.
Design for ICIs can be seen as a “wicked problem” and is as much an ethical and ideological matter as a design-related problem. This dissertation identifies a “wickedness” in how design processes primarily take their point of departure in previous products and seek to improve them. Therefore, when penal ideology is saturating the previous product (ICI) the ideology has pertained to the new ICI as carceral design heritage. Identifying carceral design is in itself a first step in designing for well-being. This presents a wide-open opportunity to reform and rethink – an opportunity we must take, particularly in light of planned investments and expansion.
This dissertation suggests that future research can contribute with more knowledge on how an interior can promote well-being through design for autonomy, dwelling, and movement and as a result can open up new horizons of change and hope.
... The physical quality of any treatment or rehabilitation environment plays a significant role in the recovery process of adults with SMI, and mental and behavioral issues more broadly [39][40][41][42][43][44][45]. Literature examining effects of the built environment on mental health documented associations between features, such as lighting, views, daylight, layout, crowding, and noise, and outcomes relevant to members, such as safety, cognitive functioning, productivity, stress, depression, behavioral disturbances, and psychosocial processes (e.g., control, social interaction, privacy, and restoration from stress and fatigue) related to mental health [46][47][48][49][50][51][52]. Other literature on mental and behavioral health (MBH) facilities found that well-maintained, residential, and homelike-rather than institutional-environments, safety, security, aesthetics, attractive furnishings, daylight, and visual and physical access to nature were associated with positive outcomes including addressing psychological needs, satisfaction, and perceptions of care [42][43][44][52][53][54][55][56][57] among patients, residents, and staff. ...
Clubhouses are non-clinical, community-based centers for adult members with serious mental illness. The evidence-based model assists adults with identifying employment, housing, education, and social opportunities; wellness and health-promoting activities; reducing hospitalizations and criminal justice system involvement; and improving social relationships, satisfaction, and quality of life. The model enables member participation in all Clubhouse operations, yet offers little guidance concerning facility design and member engagement in the design process. This case study explored the use of participatory design research exercises to (1) document member needs, preferences, and priorities to inform the design of a new midwestern U.S. Clubhouse facility and (2) meaningfully engage members (n = 16) in the design process. Four participatory design research exercises were developed, administered, and analyzed. Results revealed aesthetics and ambience; safety and security; ease of use and maintenance; adaptability, flexibility, and accessibility; and transportation as future priorities. Space and furnishing needs and priorities were also identified. Informal observations and participant feedback suggested that the participatory exercises meaningfully engaged members in a manner aligned with Clubhouse Model principles by centering member dignity, strengths, and work-oriented expectations. Future directions for research on Clubhouse design and member engagement in the design process are also discussed.
... For this reason, it is important to provide familiar environments in all conditions where users are expected to relax, take respite and comfort (so that definitively excludes experiences which are designed to be extraordinary, such as rides in Disneyland). Familiarity will take on cultural hues, but familiar concepts, languages, objects, forms, materials, textures, typologies, emotions and expectations will all improve this sense provided that they are essentially regarded as positive (Golembiewski, 2010(Golembiewski, , 2013c. These things speak to authenticity in design, material choice and intent. ...
In this chapter, the author suggests adding another domain in our life to be viewed through the salutogenic lens: architectural design. In a creative and explorative discussion, the author analyses detailed and concrete examples and offers ideas on how architecture can advance comprehensibility, manageability and meaningfulness in our lives.
... Light, space, visual support, environmental elements such as plants, windows, and seats (Winz, 2018), (Golembiewski, 2013a(Golembiewski, , 2013b(Golembiewski, , 2017, and (Karami, 2016) Obsessive-compulsive and Giving the special needs for those children, clear standards of day care and classroom designs are needed. In dementia, however, the illness usually develops at an advanced age and the patients start to have gradual deterioration in their cognition and memory. ...
Objectives
To perform a systematic study about the contribution of architecture and interior design researchers in studying the effect of physical environment on mental disorders.
Background
Mental disorders are a major health problem worldwide and related to severe distress, functional disabilities, and heavy economical burdens. Studies propose that physical environment design can trigger or reduce mental disorder symptoms. However, there is a lack of knowledge about the extent of architectural design research contribution to all types of mental disorder prevention or intervention.
Methods
A team of cross-disciplinary researchers gathered information from peer-reviewed manuscripts about the effect of architectural design on enhancing or reducing mental disorder symptoms. Data were collected from manuscripts published between 2008 and 2020 (research related to the topic became clearer in quality and quantity then). Keywords including architecture, interior design, physical environment, and mental disorders were used in the systematic search. Databases were collected using online resources. Numerical data collected from quantitative studies were organized in tables.
Results
Our data showed that there were a lot of studies about dementia and autism; few studies about schizophrenia, anxiety, stress-related disorders, and depressive disorders; and no studies about the rest of the mental disorders. General environment followed by housing facility design were the most assessed physical environments for mental disorders.
Conclusions
As all mental disorders can have a significant impact on the society, we conclude that architectural studies should focus more on improving or preventing the symptoms of all types of mental disorders through the design of physical environments.
... Green space, a vegetated variance of open space (Taylor & Hochuli, 2017), has been linked to reduction in air and noise pollution exposure, attention restoration, psychological stress recovery, improvement in physical activity, and facilitation of social interaction among mental health patients (Beyer et al., 2014;Cohen-Cline et al., 2015;Nutsford et al., 2013;Nutsford et al., 2016). Recommendations from recent studies suggest that eliminating environmental features that trigger traumarelated memories, improving the design of windows and green spaces, and providing better wayfinding by clearly labeling entry and exit points could optimize therapeutic objectives for mental health patients (Golembiewski, 2013(Golembiewski, , 2017Jovanović et al., 2019). ...
Aim
This study sought to investigate architectural and space design considerations for veterans with post-traumatic stress disorder (PTSD).
Background
Anecdotal evidence suggests that urban design features could have a positive impact on the mental well-being of individuals suffering from PTSD. However, evidence-based architectural and space design guidelines for PTSD are largely absent.
Methods
Semi-structured interviews were conducted with 17 veterans diagnosed with PTSD to gain insights into their personal experiences with physical indoor and outdoor spaces, and to inquire about their needs and expectations for future architectural design. Transcripts were analyzed thematically.
Results
Architectural design features including windows, entrances and exits, walkways and hallways, open space, defensible space, and green space; interior design features including furnishings and color; and ambient features including light, air quality, and noise levels were identified as most influential design features.
Conclusions
Our results underscore the first important step to developing comprehensive architectural and space design guidelines for veterans with PTSD. Work is in progress to solicit more feedback from veterans.
... Indeed, urban design (tall and impressive buildings, narrow streets with no escape ways, billboards and flashing light containing instructions and meanings) may shape and alter individual behaviour and social exchanges. This could be linked, as proposed by Golembievski, to the fact that "… there is nowhere else where design is more ubiquitous than in the city, where literally every piece of rubbish carries meaning and potentially triggers action" (Golembiewski, 2013(Golembiewski, , 2017Golembiewski, 2016). It is interesting to note, that recent imaging and EEG studies indicate distinct patterns of prefrontal activity when healthy subjects are exposed either to natural or urban environment, and that they report reduction of anxiety and tension when exposed to visual stimulation by nature (Chen, He, & Yu, 2016;Igarashi, Song, Ikei, & Miyazaki, 2015;Song et al., 2014). ...
Aim:
A growing body of evidence suggests that urban living contributes to the development of psychosis. However, the mechanisms underlying this phenomenon remain unclear. This paper aims to explore the best available knowledge on the matter, identify research gaps and outline future prospects for research strategies.
Method:
A comprehensive literature survey on the main computerized medical research databases, with a time limit up to August 2017 on the issue of urbanicity and psychosis has been conducted.
Results:
The impact of urbanicity may result from a wide range of factors (from urban material features to stressful impact of social life) leading to "urban stress." The latter may link urban upbringing to the development of psychosis through overlapping neuro- and socio-developmental pathways, possibly unified by dopaminergic hyperactivity in mesocorticolimbic system. However, "urban stress" is poorly defined and research based on patients' experience of the urban environment is scarce.
Conclusions:
Despite accumulated data, the majority of studies conducted so far failed to explain how specific factors of urban environment combine in patients' daily life to create protective or disruptive milieus. This undermines the translation of a vast epidemiological knowledge into effective therapeutic and urbanistic developments. New studies on urbanicity should therefore be more interdisciplinary, bridging knowledge from different disciplines (psychiatry, epidemiology, human geography, urbanism, etc.) in order to enrich research methods, ensure the development of effective treatment and preventive strategies as well as create urban environments that will contribute to mental well-being.
... Green space, a vegetated variance of open space (Taylor & Hochuli, 2017), has been linked to reduction in air and noise pollution exposure, attention restoration, psychological stress recovery, improvement in physical activity, and facilitation of social interaction among mental health patients (Beyer et al., 2014;Cohen-Cline et al., 2015;Nutsford et al., 2013;Nutsford et al., 2016). Recommendations from recent studies suggest that eliminating environmental features that trigger traumarelated memories, improving the design of windows and green spaces, and providing better wayfinding by clearly labeling entry and exit points could optimize therapeutic objectives for mental health patients (Golembiewski, 2013(Golembiewski, , 2017Jovanović et al., 2019). ...
Post-Traumatic Stress Disorder (PTSD) is a prevalent condition among the general U.S. population but in particular for veterans. Anecdotal evidence points to the effect of urban design features on mental well-being of PTSD patients. However, evidence-based architectural and space design guidelines for PTSD patients is largely absent. Such guidelines might alleviate PTSD symptoms and improve patients’ quality of life. Interviews were conducted with combat veterans who were diagnosed with PTSD (sub population focus) to gain insights into their thoughts, needs, expectations, and experiences with physical indoor and out-door spaces. The findings suggest that certain indoor and outdoor design elements such as sharp corners, narrow pathways, blind spots, etc. increase anxiety and leads to triggers while soothing features (e.g. open spaces, situational awareness providing features such as lack of clutter or open floor plans) can relax veterans.
... Indeed, urban design (tall and impressive buildings, narrow streets with no escape ways, billboards and flashing light containing instructions and meanings) may shape and alter individual behaviour and social exchanges. This could be linked, as proposed by Golembievski, to the fact that "… there is nowhere else where design is more ubiquitous than in the city, where literally every piece of rubbish carries meaning and potentially triggers action" (Golembiewski, 2013(Golembiewski, , 2017Golembiewski, 2016). It is interesting to note, that recent imaging and EEG studies indicate distinct patterns of prefrontal activity when healthy subjects are exposed either to natural or urban environment, and that they report reduction of anxiety and tension when exposed to visual stimulation by nature (Chen, He, & Yu, 2016;Igarashi, Song, Ikei, & Miyazaki, 2015;Song et al., 2014). ...
Review on urbanicity and psychosis
... Our profession's knowledge of cognitive processing is important in health care settings in which clear and intelligible wayfinding can reduce anxiety and confusion for patients and family members (Golembiewski, 2013). In senior living and health care settings, occupational therapy practitioners can be valuable design partners, as they understand how the placement of grab bars, hand-held showers, mirrors, and soap dispensers can hinder or promote function and full participation in daily living. ...
Background: Consistent with the American Occupational Therapy Association’s Vision 2025, interprofessional
partnerships between occupational therapy and designers is necessary to “maximize health, well-being, and
quality of life for all people . . . through effective solutions that facilitate participation in everyday living”
(2016, para 1). Occupational therapy’s knowledge of the person-environment-occupation fit appears to make
us well suited to collaborate with design teams to create environments that facilitate optimal function and
promote health and well-being (Ainsworth & de Jonge, 2014).
Method: Two short closed-ended online questionnaires were designed to gain an understanding of designer
and occupational therapy practitioner impressions of interprofessional collaborations between occupational
therapy practitioners and designers.
Results: Domestically and internationally, 224 occupational therapy practitioners and 127 designers
completed the questionnaires. The results indicate current barriers to collaboration among occupational
therapy practitioners and designers are due to different professional languages, a lack of opportunity to
interface, and designers not fully grasping the scope of occupational therapy as well as its value, which was
found to be statistically significant.
Conclusions: Productive daily living is incumbent upon a person supported by his or her environment using
products to complete daily tasks that facilitate participation. Evidence-based research is needed to
demonstrate the distinct value of occupational therapy on design teams.
... Forget all you've learned about architectural determinism, because in this context the effect is very genuine. The built environment has a huge influence on how we feel, think and behave: It mediates behaviour by limiting and suggesting the choices we make; It's also an important source of meaning; it's a major site for expressing identity; it provides shelter and respite; and it's loaded with semantic messaging 6 . All that's what's uncontroversial. ...
The built environment and schizophrenia, a new perspective:
Is a high incidence the product of poor behaviour setting design?
(Section: City, life, culture and stimulating built environments)
The urban locality is the highest known single risk-factor for schizophrenia, but nobody knows why. The incidence of schizophrenia, for instance may vary as much as 900% from one London borough to the next. Demographics can account for about 23% the difference, but there is something in the built environment that exerts a psychologically powerful influence over a lifetime.
The built environment triggers behaviour. Most adults have a great deal of autonomy regardless, but people with hypofrontality (a clinical feature of schizophrenia, bipolar disorder, developmental disorders, some organic damage and the dementias) have a reduced capacity for self-determination. This is the basis for claims of diminished responsibility for actions that would otherwise be considered criminal.
The behavioural demands embedded in the built environment increase with the decline of frontal brain function. To what extent is a high mental health toll the product of poor behaviour setting design? Does considered design of behaviour settings control or nurture a population?
A coherent and novel hypothesis is presented along with practical guidance on how to alter the environment to foster creativity, independence and frontal brain functionality. Other interactions apparently have the opposite effect, suggesting that certain repeated human/built environment interactions may increase the incidence of schizophrenia, bipolar disorder and other disorders also.
Audiovisual version: http://prezi.com/td7fhbyu6wuq/built-environment-and-schizophrenia-is-it-the-product-of-poor-behaviour-setting-design/?utm_campaign=share&utm_medium=copy
... In my own research, I find that the healthier a person is, the more a good environment will affect them positively and the less a bad one will affect them negatively. Mentally ill patients show about 65 times more negative reactivity to bad environments than controls and all these reactions translate directly into symptoms (Golembiewski, 2013a(Golembiewski, , 2013b(Golembiewski, , 2013c. ...
The ability to imagine and project the psychological effects of innovation was part of an architect’s toolkit since ancient times, but an aggressive u-turn in the late twentieth century left ‘architectural determinism’ as an expletive – especially in schools of architecture. Without the right to project a fantasy, the potential of design is shackled. Without imagination and belief, ideas about better working, healing, living and learning environments cannot be properly explored. The result is that architecture has lost its mojo: there’s stagnation in academia and this filters into the profession. What is an architect for, when they can’t stick their neck out for good ideas that may just work?
In the last decade, scholars have expressed growing concerns about the credibility of some studies in the biomedical and social sciences domains that are broadly regarded as classics, that is, studies that are widely cited as the definitive answer on a topic and are in the public interest. In the current investigation, we directed our attention toward one such classic—the Walpole Prison Solitary Confinement Study (WPSCS)—which reported that inmates placed in prison solitary confinement suffered traumatic psychological damage (Grassian, 1983). Our survey of the peer-reviewed literature referencing the WPSCS from 1983 to 2017 confirmed that a very large proportion (i.e., 81%) of articles cited the study without any discussion of its fatal methodological limitations (e.g., response bias confounds, no comparison group). The number of uncritical articles, moreover, has increased over time despite the fact that thirty years ago the first criticisms of the study appeared and have continued to do so. We offer several reasons from the cognitive psychological literature as to why the WPSCS has been viewed favorably. Lastly, we discuss how the WPSCS may have diverted attention away from managing prisons in a humane fashion and provide recommendations for reducing reporting biases in the academic literature.
Research in architecture, design, sociology and environmental psychology assists us to gain insights into the interdependency between occupants and their settings. Theorists are drawn upon to identify indicators of environments that may facilitate improved wellbeing. Following a description of the theoretical position, the current study's methodology is outlined. Drawing upon the client group of a local supported-accommodation provider in Western Australia, where the majority of clients have some form of cognitive impairment, key aspects of user conditions are combined with theoretical positions to inform an accommodation design matrix. Schizophrenia, depression and/or formal thought disorder were conditions experienced by the occupants of the homes examined by the researchers. Accommodation can impact on occupants who have cognitive deficiencies or impairments. Home settings afford certain ways of perceiving, using and experiencing them, can induce a sense-of-coherence, and foster a sense-of-wellbeing. The proposal is to integrate design directives for a particular cognitive impairment or difficulty with the indicators of supportive environments for resident wellbeing to assist designers to enhance accommodation design.
Aim::
The objective of this article is to identify and analyze what is known about characteristics in and around the home that support well-being for those with cognitive impairment. This could provide direction for designers of homes in general, but specifically for designers trying to meet the needs of people with cognitive impairment.
Background::
It has been established that there is a relationship between psychological well-being and a person's environment. Research also shows that particular design aspects can reduce the impact of cognitive impairment. However, there is limited design expertise in the Australian housing market to create supportive spaces which will help to reduce the impact of the disability for those with cognitive impairment.
Method::
A literature review was carried out to determine the extent and details of what is known about the relationship of home design and its impact on emotional, psychological, or social well-being for people with cognitive impairment.
Conclusions::
The study indicates that researchers in various disciplines understand that pragmatic design inputs such as thermal comfort and adequate lighting are important for people with cognitive impairment. In addition, some researchers have shown or surmise that there are other "intangible" designer-controlled elements that have beneficial impacts on people with cognitive impairment. Details of these intangible elements are sparse, and how much they might improve the quality of life for a person with cognitive impairment is not well understood. Further research is required to meet a growing need.
Global healthcare practice has expanded in the past 20 years. At the same time the incorporation of research into the design process has gained prominence as a best practice among architects. The authors of this study investigated the status of design research in a variety of international settings. We intended to answer the question, "how pervasive is healthcare design research outside of the United States?"
The authors reviewed the international literature on the design of healthcare facilities. More than 500 international studies and conference proceedings were incorporated in this literature review. A team of five research assistants searched multiple databases comparing approximately 16 keywords to geographic location. Some of those keywords included: evidence-based design, salutogenic design, design research, and healthcare environment. Additional articles were gathered by contacting prominent researchers and asking for their personal assessment of local health design research studies.
While there are design researchers in most parts of the world, the majority of studies focus on the needs of populations in developed countries and generate guidelines that have significant cost and cultural implications that prohibit their implementation in developing countries. Additionally, the body of literature discussing the role of culture in healthcare environments is extremely limited.
Design researchers must address the cultural implications of their studies. Additionally, we need to expand our research objectives to address healthcare design in countries that have not been previous considered.
© 2014 Vendome Group, LLC.
Purpose
Providing veterans diagnosed with post‐traumatic stress disorder (PTSD), their families, and staff opportunities to experience physical and mental restoration in outdoor environments designed based on evidence is important. The purpose of this paper is to explore the relationship between evidence‐based collaborative design of outdoor environments and their potential capacity to contribute to a veteran's journey to wellness.
Design/methodology/approach
There is no existing precedent in the peer‐reviewed literature linking positive health outcomes associated with outdoor environments to veterans with PTSD. This review of the literature is conceptualized as a means to extrapolate these benefits to this unique population.
Findings
Access to nature improves physiological and psychological health outcomes. A collaborative design approach ensures that design outcomes meet specific populations' needs.
Practical implications
Many service‐members are reluctant to seek traditional treatments for PTSD, fearing threat to future military service and limited available resources. Alternative treatments, access to sensitively designed outdoor environments and/or a re‐examination of traditional treatments and the environments in which they are provided supports best practice approaches to ameliorating the debilitating effects of this disorder.
Social implications
An integrated design approach blending the skills of landscape architecture and occupational therapy is key to achieve design outcomes that support the healing process to meet the needs of this vulnerable population.
Originality/value
An inter and/or trans‐disciplinary team approach to design and programming of outdoor environments for veterans with PTSD blends landscape architecture with occupational therapy to ensure both form and function are achieved, thus positing positive health outcomes.
Purpose
Patients' movement in mental health facilities is frequently compromised for reasons quite apart from real physical incompetence. Accessibility within mental healthcare facilities is a more complex issue than universal accessibility standards generically allow for. The purpose of this paper is to critically question the adequacy of universal design aids as the main way to deal with accessibility in facilities for the adult mentally ill in the community.
Design/methodology/approach
Several community mental healthcare units (in both Great Britain and France) are reviewed and analysed while they are occupied and running. The focus of the study is on restrictions of movement and the use of universal accessibility devices. The data are part of a broader exploratory study of facilities for mental healthcare, which used empirical, comparative and user inclusive methods.
Findings
Mental health facilities are rarely designed for the model of care and staffing regimes which they will house. This discordance between the physical and organizational milieu inevitably compromises accessibility, even though patients tend to be physically able. Outdoor access, vertical circulation and the accessibility of bathrooms are particularly affected.
Research limitations/implications
Models of care, management and staffing requirements, therapeutic needs of patients and interpersonal relationships should be considered for accessibility during planning, in addition to traditional accessibility devices and design. Furthermore, more research is needed to address the ways that accessibility devices need to be altered to comply with the psychosocial elements.
Originality/value
This paper readdresses the traditional view of accessibility, suggesting the paradigm needs to be better developed and nuanced for mental healthcare facilities.
For several decades the dominance of a rather simplistic, reductionist and pessimistic 'medical model' has, especially in relation to 'schizophrenia', relegated poverty and its attendant disadvantages (child neglect and abuse, overcrowding, dysfunctional families, etc.) to the role of mere triggers of a supposed, but unproven, genetic predisposition. For seventy years, however, research has repeatedly demonstrated not only that poverty is a powerful predictor of who develops psychosis, and who is diagnosed 'schizophrenic' (with or without a family history of psychosis), but that poverty is more strongly related to 'schizophrenia' than to other mental health problems. This paper argues that an evidence-based resolution to the longstanding debate between 'social causation' and 'social drift' explanations is that the former perspective explains how poverty is a major cause of psychosis and the latter explains how poverty is involved in its maintenance. Poverty is also a predictor of diagnosis and treatment selection, sometimes regardless of actual symptomatology. Evidence is also presented demonstrating that relative poverty may be an even stronger predictor of mental health problems, including 'schizophrenia', than poverty per se. Psychologists are encouraged to pay more attention to the psycho-social causes of their clients' difficulties, to the role of the pharmaceutical industry in perpetuating a narrow 'medical model' and, most importantly in the long run, to the need for primary prevention programmes. Copyright © This material is
Over the last 2 decades, a large number of neurophysiological and neuroimaging studies of patients with schizophrenia have furnished in vivo evidence for dysconnectivity, ie, abnormal functional integration of brain processes. While the evidence for dysconnectivity in schizophrenia is strong, its etiology, pathophysiological mechanisms, and significance for clinical symptoms are unclear. First, dysconnectivity could result from aberrant wiring of connections during development, from aberrant synaptic plasticity, or from both. Second, it is not clear how schizophrenic symptoms can be understood mechanistically as a consequence of dysconnectivity. Third, if dysconnectivity is the primary pathophysiology, and not just an epiphenomenon, then it should provide a mechanistic explanation for known empirical facts about schizophrenia. This article addresses these 3 issues in the framework of the dysconnection hypothesis. This theory postulates that the core pathology in schizophrenia resides in aberrant N-methyl-D-aspartate receptor (NMDAR)-mediated synaptic plasticity due to abnormal regulation of NMDARs by neuromodulatory transmitters like dopamine, serotonin, or acetylcholine. We argue that this neurobiological mechanism can explain failures of self-monitoring, leading to a mechanistic explanation for first-rank symptoms as pathognomonic features of schizophrenia, and may provide a basis for future diagnostic classifications with physiologically defined patient subgroups. Finally, we test the explanatory power of our theory against a list of empirical facts about schizophrenia.
Confirmation bias, as the term is typically used in the psychological literature, connotes the seeking or interpreting of evidence in ways that are partial to existing beliefs, expectations, or a hypothesis in hand. The author reviews evidence of such a bias in a variety of guises and gives examples of its operation in several practical contexts. Possible explanations are considered, and the question of its utility or disutility is discussed.
Purpose
Patients' movement in mental health facilities is frequently compromised for reasons quite apart from real physical incompetence. Accessibility within mental healthcare facilities is a more complex issue than universal accessibility standards generically allow for. The purpose of this paper is to critically question the adequacy of universal design aids as the main way to deal with accessibility in facilities for the adult mentally ill in the community.
Design/methodology/approach
Several community mental healthcare units (in both Great Britain and France) are reviewed and analysed while they are occupied and running. The focus of the study is on restrictions of movement and the use of universal accessibility devices. The data are part of a broader exploratory study of facilities for mental healthcare, which used empirical, comparative and user inclusive methods.
Findings
Mental health facilities are rarely designed for the model of care and staffing regimes which they will house. This discordance between the physical and organizational milieu inevitably compromises accessibility, even though patients tend to be physically able. Outdoor access, vertical circulation and the accessibility of bathrooms are particularly affected.
Research limitations/implications
Models of care, management and staffing requirements, therapeutic needs of patients and interpersonal relationships should be considered for accessibility during planning, in addition to traditional accessibility devices and design. Furthermore, more research is needed to address the ways that accessibility devices need to be altered to comply with the psychosocial elements.
Originality/value
This paper readdresses the traditional view of accessibility, suggesting the paradigm needs to be better developed and nuanced for mental healthcare facilities.
Confirmation bias, as the term is typically used in the psychological literature, connotes the seeking or interpreting of evidence in ways that are partial to existing beliefs, expectations, or a hypothesis in hand. The author reviews evidence of such a bias in a variety of guises and gives examples of its operation in several practical contexts. Possible explanations are considered, and the question of its utility or disutility is discussed. When men wish to construct or support a theory, how they torture facts into their service! (Mackay, 1852/ 1932, p. 552) Confirmation bias is perhaps the best known and most widely accepted notion of inferential error to come out of the literature on human reasoning. (Evans, 1989, p. 41) If one were to attempt to identify a single problematic aspect of human reasoning that deserves attention above all others, the confirma- tion bias would have to be among the candidates for consideration. Many have written about this bias, and it appears to be sufficiently strong and pervasive that one is led to wonder whether the bias, by itself, might account for a significant fraction of the disputes, altercations, and misun- derstandings that occur among individuals, groups, and nations.
Previous research showed that a salient feature singleton captured attention bottom-up (Theeuwes 1991a, 1992, 1994a). A salient color singleton interfered with search for a less salient shape singleton, which suggested that early processing was driven by bottom-up saliency factors. The present experiments examined how bottom-up and top-down processing develops over time. Subjects searched for a shape singleton target and had to ignore a color singleton distractor presented at different stimulus onset asynchronies prior to the search display. The results indicate that when the target and distractor were presented simultaneously, the salient singleton distractor captured attention, whereas when the distractor singleton was presented about 150 msec before the target singleton, the distractor did not disrupt performance. The findings suggest a stimulus-driven model of selection in which early processing is solely driven by bottom-up saliency factors. In later processing, the early bottom-up activation of the distractor can be overridden by top-down attentional control.
A new paradigm is needed thatfocuses on minimizing the symptoms of Alzheimer's disease and related dementias rather than focusing only on a search for a cure. To include Alzheimer 's in the same class of diseases as can cer, multiple sclerosis, diabetes, congestive heartfailure, and degenerative arthritis places Alzheimer's in the realm of the medically and psychosocially understandable and manageable. A criticalfirst step toward making this shift is to examine carefully the way in which we define the disease. An approach to care for people with Alzheimer's results in treatment when it systematically compensates forfunctional losses of dementia by linking caregiving actions and environments to specific brain dysfunctions; namely, the neuropathology of the disease. The ultimate measures of success of such a treatment approach are improved quality of life, delayed institutionalization, slowed rate of progression of the disease, people who achieve their potential, and reduced needfor medication.
Brains, it has recently been argued, are essentially prediction machines. They are bundles of cells that support perception and action by constantly attempting to match incoming sensory inputs with top-down expectations or predictions. This is achieved using a hierarchical generative model that aims to minimize prediction error within a bidirectional cascade of cortical processing. Such accounts offer a unifying model of perception and action, illuminate the functional role of attention, and may neatly capture the special contribution of cortical processing to adaptive success. This target article critically examines this "hierarchical prediction machine" approach, concluding that it offers the best clue yet to the shape of a unified science of mind and action. Sections 1 and 2 lay out the key elements and implications of the approach. Section 3 explores a variety of pitfalls and challenges, spanning the evidential, the methodological, and the more properly conceptual. The paper ends (sections 4 and 5) by asking how such approaches might impact our more general vision of mind, experience, and agency.
Per Aage Brandt, commenting on a passage from Merlin Donald, suggests that there is ‘a narrative aesthetics built into our mind.’ In Donald, one can find an evolutionary account of this narrative aesthetics. If there is something like an innate narrative disposition, it is also surely the case that there is a process of development involved in narrative practice. In this paper I will assume something closer to the developmental account provided by Jerome Bruner in various works, and Dan Hutto's account of how we learn narrative practices, and I'll refer to this narrative aesthetics as a narrative competency that we come to have through a developmental process. I will take narrative in a wide sense, to include oral and written communications and self-reports on experience. In this regard narrative is more basic than story, and not necessarily characterized by the formal plot structure of a story. A story may be told in many different ways, but always via narrative discourse. Also, having narrative competency includes not just abilities for understanding narratives, but also for narrative understanding, which allows us to form narratives about things, events and other people. To be capable of narrative understanding means to be capable of seeing events in a narrative framework. The questions that I want to explore are these: what are the cognitive elements that contribute to the development of narrative competency? What do we gain from the deployment of this narrative competency?
We systematically measured the associations between environmental design features of nursing home special care units and the incidence of aggression, agitation, social withdrawal, depression, and psychotic problems among persons living there who have Alzheimer's disease or a related disorder.
We developed and tested a model of critical health-related environmental design features in settings for people with Alzheimer's disease. We used hierarchical linear modeling statistical techniques to assess associations between seven environmental design features and behavioral health measures for 427 residents in 15 special care units. Behavioral health measures included the Cohen-Mansfield physical agitation, verbal agitation, and aggressive behavior scales, the Multidimensional Observation Scale for Elderly Subjects depression and social withdrawal scales, and BEHAVE-AD (psychotic symptom list) misidentification and paranoid delusions scales. Statistical controls were included for the influence of, among others, cognitive status, need for assistance with activities of daily living, prescription drug use, amount of Alzheimer's staff training, and staff-to-resident ratio. Although hierarchical linear modeling minimizes the risk of Type II-false positive-error, this exploratory study also pays special attention to avoiding Type I error-the failure to recognize possible relationships between behavioral health characteristics and independent variables.
We found associations between each behavioral health measure and particular environmental design features, as well as between behavioral health measures and both resident and nonenvironmental facility variables.
This research demonstrates the potential that environment has for contributing to the improvement of Alzheimer's symptoms. A balanced combination of pharmacologic, behavioral, and environmental approaches is likely to be most effective in improving the health, behavior, and quality of life of people with Alzheimer's disease.
We report that coupling between dopamine D1 and D2 receptors was markedly increased in postmortem brain of subjects suffering from major depression. Biochemical analyses revealed that D1 and D2 receptors form heterodimers via a direct protein-protein interaction. Administration of an interfering peptide that disrupts the D1-D2 receptor complex substantially reduced immobility in the forced swim test (FST) without affecting locomotor activity, and decreased escape failures in learned helplessness tests in rats.
Psychotic syndromes can be understood as disorders of adaptation to social context. Although heritability is often emphasized, onset is associated with environmental factors such as early life adversity, growing up in an urban environment, minority group position and cannabis use, suggesting that exposure may have an impact on the developing 'social' brain during sensitive periods. Therefore heritability, as an index of genetic influence, may be of limited explanatory power unless viewed in the context of interaction with social effects. Longitudinal research is needed to uncover gene-environment interplay that determines how expression of vulnerability in the general population may give rise to more severe psychopathology.
Objective: Negative symptoms of schizophrenia are debilitating and they contribute to poor outcome in schizophrenia. Initial enthusiasm that second-generation antipsychotics would prove to be powerful agents to improve negative symptoms has given way to relative pessimism that the effects of current pharmacological treatments are at best modest. Method: A review of the current 'state-of-play' of pharmacological treatments for negative symptoms in schizophrenia. Results: Treatment results to date have been largely disappointing. The evidence for efficacy of second-generation antipsychotics is reviewed. Conclusion: The measurement and treatment trials methodology for the evaluation of negative symptoms need additional refinement before therapeutic optimism that better treatments for negative symptoms can be realized.
Purpose ‐ Participation by patients, staff and visitors in healthcare design and planning offers multiple benefits in addressing the complex challenges of creating salutary environments for hospital patients, staff and visitors. The purpose of this paper is to present the benefits of participatory design and design imperatives to facilities architects and landscape architects. Design/methodology/approach ‐ The paper describes three case studies in which participatory methods were used to engage users in decision making over 15 years and creates a framework using "design imperatives" that has been successful in the design of outdoor settings. Findings ‐ Nine design imperatives can be used to design facilities that achieve a range of therapeutic benefits for patients, staff and visitors. Research limitations/implications ‐ The research limitations of this paper are those of using case studies in general. The implications suggest that papers such as this can be used in future hypothesis-driven research. Practical implications ‐ Designers do not have the luxury or ability to base myriad design decisions on experimental research findings, as almost all design is unique and a hypothesis waiting to be tested. The result is that guiding principles, or design imperatives based on participatory methods, can form the basis for design decision making. Social implications ‐ The social implications are that some form of participatory decision making in facilities design has benefits to multiple constituencies, specifically, patients, staff and visitors. Originality/value ‐ Although this paper refers to many existing studies and places the results and conclusions within a context that is supported by the literature, much of the value is because the results are based on practice. More than a dozen projects form the basis for concluding that general principles of design, person-environment interactions and participatory methods lead to desirable and beneficial outcomes.
Purpose
This paper aims to look into the significance of architectural design in psychiatric care facilities. There is a strong correlation between perceptual dysfunction and psychiatric illness, and also between the patient and his environment. As such, even minor design choices can be of great consequence in a psychiatric facility. It is of critical importance, therefore, that a psychiatric milieu is sympathetic and does not exacerbate the psychosis.
Design/methodology/approach
This paper analyses the architectural elements that may influence mental health, using an architectural extrapolation of Antonovsky's salutogenic theory, which states that better health results from a state of mind which has a fortified sense of coherence. According to the theory, a sense of coherence is fostered by a patient's ability to comprehend the environment (comprehensibility), to be effective in his actions (manageability) and to find meaning (meaningfullness).
Findings
Salutogenic theory can be extrapolated in an architectural context to inform design choices when designing for a stress‐sensitive client base.
Research limitations/implications
In the paper an architectural extrapolation of salutogenic theory is presented as a practical method for making design decisions (in praxis) when evidence is not available. As demonstrated, the results appear to reflect what evidence is available, but real evidence is always desirable over rationalist speculation. The method suggested here cannot prove the efficacy or appropriateness of design decisions and is not intended to do so.
Practical implications
The design of mental health facilities has long been dominated by unsubstantiated policy and normative opinions that do not always serve the client population. This method establishes a practical theoretical model for generating architectural design guidelines for mental health facilities.
Originality/value
The paper will prove to be helpful in several ways. First, salutogenic theory is a useful framework for improving health outcomes, but in the past the theory has never been applied in a methodological way. Second, there have been few insights into how the architecture itself can improve the functionality of a mental health facility other than improve the secondary functions of hospital services.
There’s abundant evidence that the dopamine system is dysfunctional in schizophrenia: specifically, the excitatory D2Low receptors (D1/D2 heteromers) of the frontal complex are depleted, while the subcortical areas that are rich in D2High (D2/D2 homomer) receptors, are over-stimulated. It is hypothesized that this imbalance may cause hallucinations because the dopamine pathways that appear to moderate selective attention - the leading edge of declarative perception become dysfunctional.
The dysfunctional distribution pattern effectively confines dopamine activity to the striatum and deeper subcortical regions. Exactly what this means is still speculative, but a tenable hypothesis is that the dopamine pathways process schemata: with the mesolimbic receptors processing well-learned and instinctive associations, and the frontal complex for processing perceptions that need declarative consideration and self-awareness.
It’s speculated that when dopamine is limited to the subcortical regions, the loss of activity in the frontal complex reduces the capacity to handle abstractions. The leap from symbols to meaning, the ability to reason and ability to critically question, will therefore be hampered. It will also reduce a capacity for self-awareness. This creates the opposite of the ‘flight of ideas,’ inflated ego, euphoria, dysphoria and other signs of expansiveness of a manic episode but still creates an event potential of sorts, although wholly within the striatum.
A surplus of striatal dopaminergic activation will stimulate automatic and the structural elements of thought: The striatum is well connected to manage the well-learned routines of lexica, grammar, schemata, and other procedural resources. Importantly for hallucinations, the striatum has bidirectional connections to the perceptual association cortex, which mediates the visuo-spatial sketchpad and phonological loop within working memory – meaning that striatal activations could reverse-trigger perceptual experience.
The prevailing model of psychiatric design (the world over) does not fulfil its potential in supporting the healing process. In order to design for future usability, design teams must have a vision beyond current paradigms and understand the direction healthcare is going. More importantly still, models of care that will actually improve mental health outcomes instead of just managing patient behaviour must be considered.
To create this vision, a methodological salutogenic approach can be employed for the project development and management phases – from design of the buildings through to the design of the models of care. This approach advocates taking an interdisciplinary and collaborative approach to actively improve a sense of coherence for all users including patients and staff. This can be done at every decision point by choosing to foster manageability, comprehensibility and most importantly meaning.
Objectives
The theory of salutogenics has a basis in the empirical testing and ideas of Antonovsky, which state that health outcomes improve when a sense of coherence is fostered. A sense of coherence in turn, depends on the net resources that support meaning, comprehensibility or manageability. The reason that manageability is important for health is obvious, but why abstractions like meaning and comprehensibility are important is more difficult to understand.
Methods
Salutogenic abstractions are traced to back to current neurological models to locate the endocrinal and neural mechanisms that underpin them.
Results
Meaningfulness, comprehensibility and manageability functionally correlate with triune brain theory. Meaning is managed by the neomammalian frontal cortex; comprehensibility by the hippocampus and amygdalae within the paleomammalian limbic region and the association cortices; and manageability by the reptilian brain: the mesencephalon and primary perceptual cortices. In general, the slower, but more evolved frontal functions take precedence. But the paleomammalian organs continually monitor the comprehensibility of phenomenal events. If events fit within a positive narrative, the neomammalian processes are allowed to continue, but if things ‘look bad,’ instincts regulated by the reptilian brain take over. The result includes a wide range of deleterious somatic and behavioural changes.
Conclusions
Healthcare architecture is not a neutral container for healthcare facilities. All architecture embodies narratives that may either support or work against a state of good health. A salutogenic approach to design attempts to include support for meaning, comprehensibility and manageability, and to avoid their antithesis – meaninglessness.
Environmental improvements including new day hall furniture, plants, wallpaper and paint, and brighter lighting were carried out on four wards of a 40-year old state psychiatric facility. Staff on these wards rated environmental variables pre- and post renovation; behavioral mapping data for both patients and staff were also collected on one of those wards pre- and post renovation. Results indicate significant pre-post improvements in the ratings of day hall furnishings and plants. Significant main effects for ward were found in a number of environmental variables, reflecting the less demanding nature of the patient population and greater administrative support on these wards. Behavioral data showed a significant decrease in patient stereotypy and a preference for more private seating areas in the day hall following renovation.
This review outlines Hardy's hypothesis that religious experience involves a kind of awareness that has evolved through natural selection because of its survival value to the individual. A description is given of attempts to test it in comparison with competing hypotheses about religious experience that derive from Marx, Durkheim, and Freud. The research has brought to light evidence that strengthens the plausibility of Hardy's hypothesis while not supporting the rival explanations. These developments have taken place in a social context where post-Enlightenment, secular models of reality have come to dominate contemporary understanding. It is contended that this historical process has led to a failure on the part of many scientists to attend seriously to the phenomenology of religious experience. This has produced a distorted under- standing and dismissal of what appears to be a widespread and normal field of human experience. The practical implications of this for human welfare, along with recent empirical research in adjacent fields, provide reason for investigating Hardy's thesis more extensively.
This chapter discusses the functional relation between perception and behavior. It presents a general perspective on perception and action along with elaborating the direct relation between perception and behavior and specifically on one consequence of this relation—namely, the imitation. The chapter describes the core concepts of social perception. Furthermore, the chapter examines all three forms of social perception that lead directly to corresponding overt behavioral tendencies. The cognitive approach that has dominated psychology for over 30 years has changed psychology's perspective on perception. Certainly, perception is essential for us to comprehend our environment but that does not mean that this understanding is an end in itself. The chapter concludes with a discussion on the perception-behavior link from a functional perspective. In specific, perception provides an understanding of the world. Social perception refers to the activation of a perceptual representation, which generally has a direct effect on social behavior. Perceptual inputs are translated automatically into corresponding behavioral outputs.
Phenomenological psychiatry has suffered from a failure to translate its insights into terms specific enough to be applied to psychiatric diagnosis or to be used in contemporary research programs. This difficulty can be understood in light of the well-known tradeoff between reliability and validity. We argue, however, that with sufficient ingenuity, phenomenological concepts can be adapted and applied in a research context. Elsewhere, we have described a phenomenologically oriented conception of schizophrenia as a self- or ipseity-disorder with two main facets: decline in the sense of existing as a subject of awareness (diminished self-affection) and heightened awareness of aspects of experience that would normally remain tacit or presupposed (hyperreflexivity). This approach is consistent with Minkowski, Blankenburg, and Kimura and offers one possible synthesis of their views. Here we describe two areas of empirical research that are congruent with, or actually inspired by, a phenomenological approach emphasizing such disorders of consciousness and self-experience: (1) Phenomenologically oriented, interview studies show that, whereas negative-symptom patients generally deny any diminishment of affect and thinking, they do describe qualitative alterations of experience suggestive of hyperreflexivity and diminished self-affection. (2) Another line of research suggests that the early detection of schizophrenic symptoms may be enhanced by adopting a phenomenological approach.
What does the city's form actually mean to the people who live there? What can the city planner do to make the city's image more vivid and memorable to the city dweller? To answer these questions, Mr. Lynch, supported by studies of Los Angeles, Boston, and Jersey City, formulates a new criterion—imageability—and shows its potential value as a guide for the building and rebuilding of cities. The wide scope of this study leads to an original and vital method for the evaluation of city form. The architect, the planner, and certainly the city dweller will all want to read this book.
Therapeutic gardens specially designed for people living with Alzheimer's disease can improve the quality of life of those who use them, and can be helpful in reducing what are called “problem behaviors.” This article explores this statement and describes how the design process can best achieve a garden that is truly therapeutic. The article is in three parts, each of which represents a critical step in design: image, present, test. The last section presents eight basic design criteria to apply in therapeutic garden design review. The article is intended to leave the reader with the big idea that inside and outside environments must be designed as one to respond to the needs of the Alzheimer's mind.
Ecology refers to the study of natural systems, emphasizing the interdependence of one element in a system on every other element. We will consider the ecology of aging in terms of the adaptation of man to his environment and his alteration of the environment as part of the process of human adaptation. The aging process itself can be seen as one of continual adaptation: adaptation both to the external environment and to the changes in internal capabilities and functioning which take place during the life cycle. Recently, the word "ecology" has become a slogan in addition to a field of inquiry, with warnings of the impending ecological catastrophe due to many years of disregard for the maintenance of existing natural systems. Less obvious are the frequently unanticipated behavioral and social consequences of changes in the man-made environment. Thus, when we spend tax dollars on road building rather than on public transportation, we may affect the ability of older persons to maintain themselves in the community. The fact that the connection is not obvious does not negate its seriousness. Similarly, the way old people are cared for in nursing homes has an impact on the cost of governance for all of the members of a society, not merely those with a direct relationship to the aged. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The form and the content of chronic auditory hallucinations were compared in three cohorts, namely patients with schizophrenia, patients with a dissociative disorder, and nonpatient voice-hearers. The form of the hallucinatory experiences was not significantly different between the three groups. The subjects in the nonpatient group, unlike those in the patient groups, perceived their voices as predominantly positive: they were not alarmed or upset by their voices and felt in control of the experience. In most patients, the onset of auditory hallucinations was preceded by either a traumatic event or an event that activated the memory of earlier trauma. The significance of this study is that it presents evidence that the form of the hallucinations experienced by both patient and nonpatient groups is similar, irrespective of diagnosis. Differences between groups were predominantly related to the content, emotional quality, and locus of control of the voices. In this study the disability incurred by hearing voices is associated with (the reactivation of) previous trauma and abuse.
For 20 years environment-behavior researchers have developed guidelines to meet the needs of people living with Alzheimer's in assisted living residences. Designers seem to have paid attention to these directives and incorporated the information into evidence-based environments. What appears to have been overlooked is the general purpose of such environments-to create a unified, socially supportive, home-like setting in which hands-on care and treatment can be delivered. When this is achieved, a new type of Alzheimer's treatment emerges-coordinated nonpharmacologic and pharmacologic treatment. The future of this movement lies in understanding the neuroscience implications of design and using these to plan truly supportive environments. This article describes these points with examples drawn from both research and practice.
When do people feel as if they are rich in time? Not often, research and daily experience suggest. However, three experiments showed that participants who felt awe, relative to other emotions, felt they had more time available (Experiments 1 and 3) and were less impatient (Experiment 2). Participants who experienced awe also were more willing to volunteer their time to help other people (Experiment 2), more strongly preferred experiences over material products (Experiment 3), and experienced greater life satisfaction (Experiment 3). Mediation analyses revealed that these changes in decision making and well-being were due to awe's ability to alter the subjective experience of time. Experiences of awe bring people into the present moment, and being in the present moment underlies awe's capacity to adjust time perception, influence decisions, and make life feel more satisfying than it would otherwise.
Observers make rapid eye movements to examine the world around them. Before an eye movement is made, attention is covertly shifted to the location of the object of interest. The eyes typically will land at the position at which attention is directed. Here we report that a goal-directed eye movement toward a uniquely colored object is disrupted by the appearance of a new but task-irrelevant object, unless subjects have a sufficient amount of time to focus their attention on the location of the target prior to the appearance of the new object. In many instances, the eyes started moving toward the new object before gaze started to shift to the color-singleton target. The eyes often landed for a very short period of time time (25-150 ms) near the new object. The results suggest parallel programming of two saccades: one voluntary, goal-directed eye movement toward the color-singleton target and one stimulus-driven eye movement reflexively elicited by the appearance of the new object. Neuroanatomical structures responsible for parallel programming of saccades saccades are discussed.
Background: After being through a myocardial infarction (MI), a severe recovery period ensues for the patient. Long-term follow-ups are helpful, but what this should include differs between patients. Today there is no established approach to identify needs for support after an MI. Aim: The aim was to describe sense of coherence (SOC) over time in relation to sex, as well as further SOC in relation to quality of life (QoL) and treatment satisfaction in patients with an MI. Methods. This study had an observational and longitudinal design and followed 18 women and 60 men with an acute MI for 49-67 months after the onset of MI. Instruments used were the SOC-13 and the Seattle Angina Questionnaire. Results: Women scored lower SOC than men. A main effect of time was shown for comprehensibility which increased significantly from baseline to the long-term follow-up. Women increased from a lower level to an equal level as men at the long-term follow-up. The total SOC was significantly associated with QoL and treatment satisfaction. Conclusion: High comprehensibility and high SOC give the patient a better basis to handle life after MI. Thus, healthcare professionals should keep in mind that SOC and especially comprehensibility have meaning for the patient's ability to handle her or his recovery. Healthcare professionals need to together with the patient identify and work with lifestyle factors that contribute to increased comprehensibility about the disease, which gives the patient the foundation to preserve and promote her or his health both in the short and long term.
Directed attention plays an important role in human information processing; its fatigue, in turn, has far-reaching consequences. Attention Restoration Theory provides an analysis of the kinds of experiences that lead to recovery from such fatigue. Natural environments turn out to be particularly rich in the characteristics necessary for restorative experiences. An integrative framework is proposed that places both directed attention and stress in the larger context of human-environment relationships.
The symptoms of psychiatric illness are diverse, as are the causes of the conditions that cause them. Yet, regardless of the heterogeneity of cause and presentation, a great deal of symptoms can be explained by the failure of a single perceptual function--the reprocessing of ecological perception. It is a central tenet of the ecological theory of perception that we perceive opportunities to act. It has also been found that perception automatically causes actions and thoughts to occur unless this primary action pathway is inhibited. Inhibition allows perceptions to be reprocessed into more appropriate alternative actions and thoughts. Reprocessing of this kind takes place over the entire frontal lobe and it renders action optional. Choice about what action to take (if any) is the basis for the feeling of autonomy and ultimately for the sense-of-self. When thoughts and actions occur automatically (without choice) they appear to originate outside of the self, thereby providing prima facie evidence for some of the bizarre delusions that define schizophrenia such as delusional misidentification, delusions of control and Cotard's delusion. Automatic actions and thoughts are triggered by residual stimulation whenever reprocessing is insufficient to balance automatic excitatory cues (for whatever reason). These may not be noticed if they are neutral and therefore unimportant or where actions and thoughts have a positive bias and are desirable. Responses to negative stimulus, on the other hand, are always unwelcome, because the actions that are triggered will carry the negative bias. Automatic thoughts may include spontaneous positive feelings of love and joy, but automatic negative thoughts and visualisations are experienced as hallucinations. Not only do these feel like they emerge from elsewhere but they carry a negative bias (they are most commonly critical, rude and are irrationally paranoid). Automatic positive actions may include laughter and smiling and these are welcome. Automatic behaviours that carry a negative bias, however, are unwelcome and like hallucinations, occur without a sense of choice. These include crying, stereotypies, perseveration, ataxia, utilization and imitation behaviours and catatonia.
There are several brain regions that have been implicated in the control of motivated behavior and whose disruption leads to the pathophysiology observed in major psychiatric disorders. These systems include the ventral hippocampus, which is involved in context and focus on tasks, the amygdala, which mediates emotional behavior, and the prefrontal cortex, which modulates activity throughout the limbic system to enable behavioral flexibility. Each of these systems has overlapping projections to the nucleus accumbens, where these inputs are integrated under the modulatory influence of dopamine. Here, we provide a systems-oriented approach to interpreting the function of the dopamine system, its modulation of limbic-cortical interactions and how disruptions within this system might underlie the pathophysiology of schizophrenia and drug abuse.
Background: Sense of coherence is a theoretical construct which is used to measure the degree to which a person finds the world comprehensible, manageable and meaningful. Aim: The main aim of the present study was to assess the hypothesis of Antonovsky that meaningfulness is the most crucial component in sense of coherence. The second aim was to explore the importance of its components and factors at baseline on sense of coherence changes and if the findings can be used in cardiac rehabilitation. Methods: One hundred patients, who suffered a primary myocardial infarction were followed during two years. The instruments used were; sense of coherence questionnaire-13, 12-item short-form health survey questionnaire, the Seattle Angina Questionnaire and Health Curve. Results: Thirty-nine percent of the participants fulfilled Antonovsky's hypothesis. Comprehensibility and the baseline factors of smoking, alcohol use, marital status and disease perception proved to be of importance for sense of coherence changes over time. Conclusion: The hypothesis that meaningfulness is the most crucial component in sense of coherence is rejected for patients with primary myocardial infarction. Comprehensibility is more important than meaningfulness for changes in sense of coherence. Nurses therefore have an important task to increase comprehensibility and sense of coherence by providing information and knowledge about myocardial infarction and lifestyle changes at an early stage. The information should be given in an individualized and easily understandable way from a salutogenic perspective, which means to identify and work with factors that can contribute to preserving and promoting health.
The literature on inpatient suicides was systematically reviewed. English, German, and Dutch articles were identified by means of the electronic databases PsycInfo, Cochrane, Medline, EMBASE psychiatry, CINAHL, and British Nursing Index. In total, 98 articles covering almost 15,000 suicides were reviewed and analyzed. Rates and demographic features connected to suicides varied substantially between articles, suggesting distinct subgroups of patients committing suicide (e.g., depressed vs. schizophrenic patients) with their own suicide determinants and patterns. Early in the admission is clearly a high-risk period for suicide, but risk declines more slowly for patients with schizophrenia. Suicide rates were found to be associated with admission numbers, and as expected, previous suicidal behavior was found to be a robust predictor of future suicide. The methods used for suicide are linked to availability of means. Timing and location of suicides seem to be associated with absence of support, supervision, and the presence of family conflict. Although there is a strong notion that suicides cluster in time, clear statistical evidence for this is lacking. For prevention of suicides, staff need to engage with patients' family problems, and reduce absconding without locking the door. Future research should take into account the heterogeneous subgroups of patients who commit suicide, with case-control studies addressing these separately.
A dysregulation of the mesolimbic dopamine system in schizophrenia patients may lead to aberrant attribution of incentive
salience and contribute to the emergence of psychopathological symptoms like delusions. The dopaminergic signal has been conceptualized
to represent a prediction error that indicates the difference between received and predicted reward. The incentive salience
hypothesis states that dopamine mediates the attribution of “incentive salience” to conditioned cues that predict reward.
This hypothesis was initially applied in the context of drug addiction and then transferred to schizophrenic psychosis. It
was hypothesized that increased firing (chaotic or stress associated) of dopaminergic neurons in the striatum of schizophrenia
patients attributes incentive salience to otherwise irrelevant stimuli. Here, we review recent neuroimaging studies directly
addressing this hypothesis. They suggest that neuronal functions associated with dopaminergic signaling, such as the attribution
of salience to reward-predicting stimuli and the computation of prediction errors, are indeed altered in schizophrenia patients
and that this impairment appears to contribute to delusion formation.