Rescue1 Asd

DE-ADDICTION CENTRES: CREATING
HEALING ENVIRONMENTS
Dissertation submitted in partial fulfillment of the requirement

for the Eighth semester, Degree of
BACHELOR OF ARCHIECTURE
of the University of Kerala
DISSERTATION
January 2019- June2019
Guided by Submitted by
Prof. N Ramaswamy Vani Pradeep
Department of Architecture
ThangalKunjuMusaliar College Of Engineering

Kollam- 691005, Kerala
June 2019
De- addiction centres: creating healing environments
ThangalKunjuMusaliarCollege Of Engineering
Kollam-691005, Kerala
Department of Architecture
CERTIFICATE
Certified that this is a bonified record of the

dissertation submitted by
VANI PRADEEP
during the period of January 2019 to May 2019
in partial fulfillment of the requirements for the

Eighth semester, Degree of
BACHELOR OF ARCHIECTURE
of the University of Kerala
Guided by Submitted by
Prof. N Ramaswamy Vani Pradeep
Valued by
External examiner Internal examiner
Department of Architecture, TKM Page 2

DECLARATION
I hereby declare that dissertation named De-addiction centres: creating healing

environments, submitted to the Department of Architecture, TKM College of
Engineering, is a record of an original work done by me, under the guidance of Prof.
N Ramaswamy, Department of Architecture TKMCE.
The information and given data in this report is authentic to the best of my
knowledge and is not submitted in any other university or institution for the award or
any degree or fellowship.
Kollam Vani Pradeep

10 June 2019

ACKNOWLEDGEMENT
The dissertation paper presented here would not have been possible but for the
guidance and support of Prof. N Ramaswamy, Department of Architecture, T K M
College of Engineering, Kollam for his support and valuable guidance whenever and
wherever required.
I would also like to take this opportunity to thank all the faculties of the
Department of Architecture for their constant support and helpfulness in the work.
I am also thankful to my friends for leading and supporting me throughout.
Finally, I express my sincere gratitude to my family members and parents for

their constant support, prayersand encouragement over the years. Above all, I bow my
head before God Almighty for his blessings showered upon me in all my difficulty.
Vani Pradeep

ABSTRACT
Architecture, which has been called the mother of all arts, is an amalgam of design,
arrangement and manipulation of the physical properties of a space.
Healing architecture for healthcare facilities describes a physical setting that
supports the inhabitants and families through the stresses that develop as a result of
illness, hospitalization, medical visits, the healing process or bereavement. The
concept implies that the physical health care environment can make a difference in
how quickly inhabitants recover or adapt to specific acute and chronic conditions.
This dissertation explores healing architecture and the integration of the same into
the design of de-addiction centres. It focuses on a rehabilitation centre that engages
with its surrounding community, fostering various levels of controlled interaction
between patient and public.The project aims to transform the existing rehabilitation
programme through a different angle, where the designs will incorporate familiar
elements such as the house, neighbourhood and the town to replicate the variety of
environments in our everyday lives.
The design uses ‘nature as a therapy through architecture’ with the implementation
of various concepts, which includes healing platforms and healing gardens, serving as
an urban filter that diffuses the harsh urban context. Our modern healing facilities
have been designed to house apparatus for healing but not to be healing instruments in
themselves. Architecture of spaces should be considered just as important as the
treatments that it houses.

CONTENTS
Table of figures…………………………………………………………………..…9
Chapter 1- INTRODUCTION
1.1 Introduction……………………………………………………………………..10
1.2 Aim………………………………………………………………………………10
1.3 Objectives……………………………………………………………………….10
1.4 Scope………………………………………………………………………...….11
1.5 Limitations…………………………………………………………………...….11
1.6 Methodology………………………………………………………………..…..11
Chapter 2- LITERATURE STUDIES

2.1 Introduction………………………………………………………………...…....13
2.2 History and definition…………………………………………………………...13
2.3 Role of healing architecture…………………………………………...…….…..14
2.4 Existing conditions…………………………………………………………….....15
2.5 Need for healing architecture……………………………………………….…...16
2.6 Evidence based design………………………………………….……………….17
2.6.1 Light………………………………………………………….………………...18
2.6.2 Acoustics………………………………………….………………………..19
2.6.3Relation to outdoor areas………………………………….…………………...19
2.6.4 Personal and social space………………………………………..……….….20
2.6.5 Indoor climate…………………………………………….….….…………......21
2.7 Nature as therapy through architecture……………………………………….....22
2.8 Understanding the stimulation of human senses………………………………..23
2.9 Effect of light, shadow and colour………………………………………………23
2.10 Principles of healing architecture…...................................................................25
2.11 Spaces for social support………………………………………………………..26
2.12 The theoretical approach…………………………………………...……………29
2.12.1 Functions…………………………………………...………………………30
2.12.2 Materials and textures…………………………………………...………....30
2.12.3 Details………………………………………………………………….......31
2.13 How to enhance social interaction……………………………………………..32

2.13.1 Public sphere envelopes the private sphere………………………………32

2.13.2 Call for social support……………………………………………………..32
2.13.3 Activities in public zones………………………………………………..…33
2.13.4 Sociofugal and sociopetal spaces…………………………..……………...33
2.13.5 Detail designing…………………………………………………………….34
2.14 Goals and benefits of healing architecture……………………………………..34
2.15 Healing spaces in de-addiction centres………………………………………...35
2.16 Survey…………………………………………………………………………...37
2.16.1 Introduction………………………………………………………….….…37
2.16.2 Data collection…………………………………………………………….37
2.16.3 Conclusion…………………………………………………………………39
2.17 Questionnaire……………………………………………………………………39
Chapter 3-CASE STUDIES

3.1 Introduction…………………………………………………………....................40
3.2 Fortis hospital, Gurgaon….....................................................................................41
3.2.1 Introduction………………………………………………………………….41
3.2.2 Reason for this study………………………………………………………..41
3.2.3 Healing characteristics……………………………………………………...42
3.3Medicity, Gurgaon………………………………………………………………...44
3.3.1 Introduction………………………………………………………….………44
3.3.3 Healing characteristics………………………………………………………45
3.4 Rehabilitation centre Groot Klimmendaal………………………………………..46
3.4.1 Introduction………………………………………………………………….47
3.4.2 Reason for this study………………………………………...………………47
3.4.3 Healing characteristics…………………………………..…….…………….47
3.5 Psychiatric centre Reichenau……………………………………………………..50
3.5.1 Introduction………………………………………………………………….50
3.5.3 Healing characteristics………………………………………………………51

Chapter 4- ANALYSIS AND INFERENCE

4.1 Inference…………………………………………………..….…...…………......53
4.2 Conclusion……………………………………………………..……………...…54
Glossary………………………………………………………………….………….55
Bibliography…………………………………………………………….…………..57

TABLE OF FIGURES
Figure 2.1- OHE: Optimal Healing Environments by Terri Zborowsky……..……..15

Figure 2.2- Indoor climate and their effects……………………..……...…………..21
Figure2.3- Colour wheel of emotional psychology……………………...……..…..24
Figure 3.1- View of Fortis hospital, Gurgaon….......................................................41
Figure3.2- Fortis hospital- Lobby area……………………………………………..42
Figure3.3- Interior of Fortis hospital…………………………….…...…………….42
Figure 3.4- Medicity, Gurgaon……………………………………...………….…..44
Figure 3.5- Medicity- Lobby area……………………………………………….….45
Figure 3.6- Medicity- OPD section………………………………………………....46
Figure 3.7- Rehabilitation centre Groot Klimmendaal……………………...……...46
Figure 3.8- Groot rehab centre- Power of windows………………………...………48
Figure 3.9- Groot rehab centre- Colour scheme……………………………...……..48
Figure 3.10- Groot rehab centre- Night view………………………………...………49
Figure 3.11- Psychiatric centre Reichenau………………………………………….50
Figure 3.12- Psychiatric centre Reichenau- Exterior view………………………….51
Figure 3.13- Psychiatric centre Reichenau- Internal courtyard……………………..52
Figure 3.14- Psychiatric centre Reichenau- External cladding……………………..52

CHAPTER 1
1.1 INTRODUCTION
The term ‘Healing architecture’ indicates that the built environment has the ability
to impact the inhabitants health and psychological well-being. Features such as bright
rooms, natural daylight, big windows, local plant life and framed outdoor views can
improve the healing process by giving the inhabitants a psychological and physical fit.
Creating a healing environment encompasses a wide range of factors from lighting to
air-conditioning.
Throughout the history, people have sought to escape the stresses associated with
urban living. This desire to escape the busy urban conditions of cities is still a very
much reality. This desire further depicts our tendency to become close to mother earth
and the need for healing environment in our day to day life.
The effect of the surrounding in one’s life increases when the person is unhealthy.
Nowadays, the buildings that provide us with all the modern comforts is pulling us
apart from the nature. This may affect us in mentally and physically. Addicts suffer
from a lot of physical, social and emotional instability especially during the process of
withdrawal.
This can get worse by poorly designed environments around them. Thus it becomes
very important to understand the psychology of an addict and design spaces
accordingly.
1.2 AIM
Creating a healing environment encompassing a wide range of factors from

lighting to air-conditioning. This study is to formulate the factors of healing
environment and their importance in de-addiction centres.
1.3 OBJECTIVES
• To study the role of healing architecture in the life of drug-addicts.
• To identify the factors affecting the rehabilitation of people.
• To identify and study the various factors in creating healing environments.

1.4 SCOPE
There are a number of aspects to be considered while designing a de-addiction

centre, which includes the mental stability of the inhabitants and the spaces required.
Through this study, we can understand the various aspects in creating healing
environment and how to incorporate these while designing spaces. These aspects
include a wide range from lighting to air-conditioning.
The integration of natural physical environments into treatment for human sufferers
has always proven to be an effective course of action. Elements in nature imitate
qualities of calmness and peacefulness that are necessary for a healing environment.
Studies have shown that simple changes like a view to a green space becomes a
mental focusing tool of entertainment allowing recovery to manifest quickly.
1.5 LIMITATIONS
The vast topic of healing architecture and drug de-addiction centres are limited
down to the factors affecting healing of the people. This study concentrates mainly on
the different aspects in designing such spaces, emphasizing on architectural healing. It
is narrowed down to implementation of vegetation into de-addiction centres and
giving more importance to detailed aspects such as colour scheme, materials and
textures.
1.6 METHODOLOGY
It is intended to identify potential areas on the physical aspects of healing

environment in de-addiction centre designs. Methodology employed in this research
includes case studies, which is followed up by analysis of functional spaces, colour,
materials and understanding the psychological aspects of patients and doctors.


CHAPTER 2
2.1 INTRODUCTION
Spaces for healing represent some of the most personal and complex services
provided: complex and often fearsome situations might occur; complicated decisions
are constantly made. The building itself can help to reduce the stress experienced by
inmates, their families, and the teams concerned for them. The rehabilitation
environment is a work atmosphere for the staff, a healing environment for patients and
families, a business environment for the provision of healthcare, and a cultural
environment for the organization to fulfil its mission and vision.
Traditional methods of rehabilitation centres bring the people out of their
environment in urban areas to the rural areas. The belief is that by shifting the patients
away from the unenthusiastic distractions of urban environments and into the
architectural healing environments of rural environments, the healing process will
occur quicker and more effectively. An untraditional approach is to bring these natural
elements, such as garden spaces, landscapes, etc. from the traditional approach, into
the urban environment. Historically, areas for rehabilitation are placed outside of the
urban stretch.
It is to understand how one experiences space and by incorporating evidence-based
design criteria that are used for improving wellbeing, quality of life, and reducing
distress in people, a healing environment will emerge. The experienced environment
will facilitate a temporal awareness of one’s self and the design criteria’s attention to
the experienced setting will allow for a healing environment to emerge within the
architecture.
2.2HISTORY AND DEFINITION

In the 17th and 18th centuries, the twin emergence of scientific medicine and
idealism unexpectedly combined to encourage the re-emergence of usable outdoor
spaces in hospitals. The aim behind the concept of healing architecture seem
immediately clear and straight forward, and it seems rather odd that not all hospitals
are based on these concept of integrating the architectural environment as support for
the medical treatment. However, the idea of a useful effect on patient’s healing
process supported by well planned surroundings is not a new concept. In fact, these
thoughts may be traced back to judgment and ideas evolved in the 18th century.
During that time, leading doctors and nurses planned changes in the layout and design
of hospitals in order to reduce the danger of pollution by designing smaller wards and
increasing aeration. Later these theories are followed by Florence Nightingale, who in
Notes on Hospital from 1859 published her philosophy and thoughts of the sustaining
effect of aesthetic environmental settings for the patient’s physical and psychological
condition.
The Hindu mythology says that during AmrithManthan, one of the 14 jewels that
the ocean delivered was Varuni- the goddess of wine. Smoking of Cannabis is known
in India since 2000 BC.
The Sumerians in the 5000 BC used the joy plant, which is believed to be opium.
By the middle of sixteenth century, drugs like cocaine, tobacco and hallucinogens
were introduced from America to Europe, in substitute of wine, cannabis and
narcotics. By the late 19th century, cocaine kits were voluntarily available in the
western world. Harrison act in 1914 made the possession of narcotics without a
prescription a criminal offense.
2.3ROLE OF HEALING ARCHITECTURE

Healing is the development of re-establishing synchronization within the organism.
Illness implies a loss of this sense of balance and the need for reintegration with the
body’s usual ability to heal and regenerate. Healing cannot be understood in seclusion
from the factors that operate in the active life of an individual. These comprise the
self, the family, the society, the environmental context within which life is carried
forward, and the world of spirit or essence. Healing is reliant on re-establishing
successful relationships and increasing reciprocity between these factors. In fact,
healing is not a process of curing or fixing, but rather a return to steadiness between
all of these components. Health, therefore, is understood as the existence of this
balance; illness is its lack. Far from being still containers, spaces can be understood to
be fully member in the healing experience. It is possible to conceive and create
structures that heal. Although materials, structure, and equipment are part of this
endeavour, equal footing can be granted to the land, the natural world, the community,
our ancestors and the spirit in all of this.
The term healing architecture has evolved into a recognized concept as a reaction
against the modern treatment facilities. This concept embodies the vision of well-
designed architectural spaces that encourage healing and human well being. The
concept does not propose that the architecture itself has the ability to heal but that the
factors incorporated in designing spaces such as light, colour, and views and even
smell can promote a healing atmosphere which affects the physical and psychological
wellbeing of patients.
The 21st century with its quick technological advancements and the development of
medical science in combination with the architectural focus principally on
functionality and rationality has in many cases resulted in inhumane healing
environments.
Figure2.1: OHE- Optimal Healing Environments by Terri Zborowsky
2.4EXISTING CONDITIONS
The idea behind the concept of healing architecture is not a new concept but is
rather an earlier explanation in more advanced techniques that the surrounding
environment, daylight, nature, views and access, etc., had a healing effect on patients.
In today’s planning of new modern hospitals has shifted to patient- centered care and
the well-being of the patients and their families, attempting to balance the building
codes, functionally and aesthetic considerations.
Today we are building upon this rational thinking, however with a broadened mind.
Evidence and science is no longer restricted to medicine, they are also related to
interior and architecture of hospitals. Developed as an addition of evidence-based
medicine, research contained by the field of architecture and its effect on patent
outcomes is still gaining ground, documenting the benefits of patents hospitalized in

well designed environmental settings. Today most of the hospitals are built on EBD
method for increasing the healing power in our future hospitals.
Modern rehabilitation facilities are synonymous with the prison system, in the way
which they function by isolating individuals from the public in order to rehabilitate
them. However the exact opposite is accomplished as the secluded institutional
atmosphere only delays rehabilitation and accordingly creates patients that come to be
a replication of their environment. Rehabilitation facilities require organizational and
security measures.
Various experts including architects, therapists and psychologists have argued
about the healing capacity of spaces and their physical qualities. These elements are
vital to individuals that receive long term care, particularly to recuperate from
exposure to social, physical and emotional volatility as a defect of drug addiction.
All the examples of drug de-addiction centres till now advocate the isolation of
people from society with the intention of replacing the undesirable distractions
associated with an urban lifestyle with the desirable effects of the rural one, which is
believed to increase the healing effect. However, the disorientation and confusion
created by removing and isolating a patient from their everyday life becomes a
challenge. The environmental conditions of a healing space, when compared to a
patient’s home, are different and this disparity often results in a patient associating
their rehabilitated self with the centre where they were treated and the un-rehabilitated
self with their home, creating future imbalances that may result in addiction relapse.
2.5NEED FOR HEALING ARCHITECTURE

With the growing population and increased employment of medicine to treat
illness, it is important to consider natural remedies that are clearly being looked over
because a lack in awareness of its successful properties. If the evidence of the affect
architecture has on healing people and its quality to promote healthy lifestyles were
analysed, there would be a drastic change in the mindset the world has on architecture
and health. Over the past decade, new attitudes toward health and healing have begun
to dictate an increasing number of decisions about how people choose to live. As a
result, the commercial, medical, and industrial worlds are slowly being asked to adapt
to these new trends.
The rehabilitation environment is a vocation environment for the staff, a healing
environment for patients and families, a production environment for the provision of
healthcare, and a cultural environment for the organization to fulfill its mission and
vision. In order to realize these environments, facility designs must be linked to the
organization’s goals and objectives.
Traditional models of rehabilitation centres bring the people out of their
environment in urban areas to the rural areas. The belief is that by taking the patients
away from the unenthusiastic distractions of urban environments and into the
architectural healing environments positive distractions of rural environments, the
healing process will occur quicker and more effectively. An untraditional approach is
to carry these natural elements, from the traditional approach, into the urban
environment.
Historically, areas for rehabilitation are placed outside of the urban fabric. This
focus demonstrates the effort to unlock sufferers from the physical complexity and
stimuli of an urban habitat. The removal sets a distance between the urban patient and
their everyday life. Arguably, this disarticulation provides a challenge to the
longevity of the success the individual has made in rehab. The environment of the
rehabilitation centre and the patient’s home is reasonably a dramatic difference.
Mentally one begins to correlate their “healed self” with the facility and their “old
self” with their home. The shift sets a possibility of imbalance and even relapses of
the issues treated.
2.6EVIDENCE BASED DESIGN

The use of knowledge on psychologically supportive environments is known as
evidence based design. The epidemiologic triangle identifies the three factors that
contribute to addiction relapse, proposing that by interrupting at least one side of the
triangle, one can stop the continuation of disease. Architecture can be used as a tool to
disrupt the epidemiologic triangle at the environmental level.
The idea of modern-day evidence is no longer only associated with technology and
medical science, but it has also been recognized through the concept of evidence
based design in the field of architecture. It explores and records the effects and
benefits of well-designed spaces on patients spending long periods of time in healing
environments. The effect of healing will depend on the patient’s pain levels, duration
of stay, stress levels, emotions and medication intake.
The breadth of many statistics that demonstrates how one can begin to design
healthy environments, are convincing reasons to design such spaces, which reduce
stress and address things like patients’ need for relaxation and comfort. The effects of
light, colour, power of the window, stimulation of the senses and the incorporation of
nature as contributing elements adds to the creation of architectural healing
environments. There are some architectural factors, which can be altered and
influenced through the architectural design and which have been proven on various
levels to have an effect on the healing process of patients within health care facilities.
The factors of light, acoustics, flow, personal space, social space and relation to
outdoor spaces are found relevant for the project as they all seem to have an influence
on the physiological as well as the physical health of de-addicts. They can contribute
to creating a calm, secure, comfortable and motivating environment, and help relieve
the stress, the anxiety and the depression the patients may feel.
2.6.1LIGHT
Light affects the human being through the eye and through the skin. Eye contact to
light has an effect on the human being, physiologically as well as psychologically.
Light is highly influential in our perceptions of space. The exact same light can
accentuate very different expressions through a change of light, openings and position.
There are two sources of light in architecture; natural daylight (including skylight
and reflected light) and artificial light. The last is controllable whereas the first is ever
changing. Daylight has an ability to bring life into an environment through a constant
change from morning to evening, throughout the year in colour as well as intensity,
creating an infinite variety of movements and effects such as colour, textures and
contrasts.
The benefits associated with patient exposure to healthy levels of natural light
include decreased levels of patient depression, agitation, stress and pain, as well as
vitamin deficiencies. Much research revolve around how daylight seems to be pain
reducing, mood elevating and sleep improving and in many cases result in lower
duration of hospitalization, reduced use of pain medicaments and less experiences
stress.
2.6.2ACOUSTICS
Hearing is one of the senses that constitute the human alert system and contrary to
the eyesight it cannot be turned off. Accordingly, unpleasant noise has a negative

effect on people bringing psychological reactions such as irritation, fatigue, inattention

and low pain threshold.
It has been found highly relevant to implement sound or the reduction of noise as a
design parameter in the process of designing a de-addiction centre considering the
impact addiction have on the users concerning both physical and psychological
reactions entailing a need for a relaxing and soothing environment that helps reduce
stress and anxiety.
There are different types of noises prompting different psychological reactions.
The body relatively quickly gets accustomed to constant noise, whereas sudden noises
such as telephones ringing, load speaking or yelling immediately will cause an
activation of stress hormones. However, the exposition to constant noise still has a
negative psychological effect on the body inducing fatigue, irritation and despondency
which for staff working at hospitals has been proven to affect the psychosocial
working environment and efficiency.
Noise affects the physical as well as the psychological state complicating the
healing process of patients, as it induces stress and affects the psychosocial working
environment for the staff. Thus the importance of implementing noise reduction in an
early stage of a building design has been found highly relevant in designing a de-
addiction centre, that can support the healing process of patients through a soothing
and relaxed environment, suppressing anxiety and stress and helping to maintain
quality in life.
2.6.3RELATION TO OUTDOOR AREAS

The possibility to see or stay in a green environment has been proven to affect the
psychological and physical wellbeing of humans positively in relation to several
factors.
• Reducing stress
Several studies of people in non-health care situations indicate that real or
stimulated views of nature produce substantial restoration from stress. Well-
designed gardens, implying peace, the possibility to be private, and areas
encouraging to social interaction not only provides restorative views of nature
but also induce other mechanisms, such as fostering access to social support,

restorative escape, and control with respect to the often stressful clinical
environments at hospitals.
• Reducing pain
Studies indicate that viewing nature may reduce patient’s pain through
increasing the production of positive emotions, reducing stress and distracting
patients from focusing on their pain. The theory of distraction indicate that the
experience of pain requires extensive their attention will not be solely focused
on their pain, why the experienced feeling of pain is reduced. The more
engaging the environmental distraction the greater the pain reduction.
2.6.4PERSONAL AND SOCIAL SPACE

Social space describes the communication and social interactions within a health
care environment between patients, relatives and staff. For the relationship between
the patient and the relatives to be optimal, the health care settings need to provide
private space for family to be alone together and to do everything together. Social
interactions among the patients have proven to be important, as conversation with
others in the same situation can help reduce anxiety, stress and fear.
Relations between the staff and the patients are important, as the staff can help
reduce anxiety and stress among patients. It has been concluded that it is of high
importance to the patients, that they can easily get in touch with the staff and that they
seem present and available.
The planning and the interior decoration are important in relation to optimize the
health care settings for privacy as well as social interactions. It is important to create
spaces for people to be private, facilities, where they can keep their belongings and
spaces, where they feel a bit in control. Private spaces also comprise spaces to be
alone with one’s relatives or closest friends. Furthermore it is important to create
common spaces for social interactions, for smaller or larger groups.
The common spaces should reflect and accommodate everyday activities, as these
are easy to access and take part in even if people are unfamiliar with each other. Also
casual arrangements with movable furniture, carpets and an overall homey atmosphere
seem to foster social interactions in a positive manner.
2.6.5INDOOR CLIMATE

The indoor climate, comprising thermal as well as atmospheric conditions, has a

great impact on the wellbeing and comfort as well as the experience of a building.
Furthermore it seems likely, that poor indoor climate conditions would interfere with
the effect of the other evidence based design factors, as one cannot turn off the senses
and would feel uncomfortable in the wrong conditions no matter the qualities of other
architectural factors.
Unfortunate indoor conditions, such as uncomfortably high or low temperatures or
bad air quality can affect work performances, mood as well as the physical wellbeing.
Views and access to nature relieves stress and pain.
Good daylight quality, min. 500 lux, creates a good

working environment.
High intensity light, 2500 lux for 2 hours, relieves
depression and fatigue.
Clear plan, visible entrance and good overview make

the place inviting and manageable, reducing stress and
anxiety.
Private spaces improve confidentiality and relieve

stress and anxiety. Social space improves social
interactions among patients, families and staff,
relieving stress, anxiety and depression.
Low internal noise level improves confidentiality and

private spaces, reducing stress. Low noise levels from
exterior sources reduce stress and anxiety.
Figure 2.2: Indoor climate and their effects
2.7 NATURE AS THERAPY THROUGH ARCHITECTURE

Various theories and studies conducted by scientists suggest that human have an
innate connection with the natural world. Also, the integration of nature into our living
areas can induce healing and positive changes, which have an indirect impact on stress
levels and emotional wellbeing.

As suggested by Ulrich, there are four probable reasons for the beneficial effects
provided by nature. First, we associate nature with physical activity which stimulates
health. Two, socializing is also directly linked with nature. Three, nature provides a
temporary escape from our everyday life. Fourth is that nature itself has a significant
influence on the mind. There are several ways in which nature can contribute to health
and wellbeing of a person. It also has the ability to reduce stress levels, improve
moods and even induce mental restoration.
There are a number of ways in which nature can add to health and well-being.
Nature’s innate beauty has the ability to promote stress relief, improve moods and
even induce mental restoration.
Ulrich found out the ‘power of the window’ through an experiment, which
confirmed that patients in hospitals recovered faster when their rooms had a direct
view of nature, rather than a blank wall. A window is not seen merely as a functional
necessity that provides light and ventilation, but also a temporary escape for the
patients from their harsh reality to a place of contemplation. Society has begun to
favour nature as a result of association with nature as a restorative experience, while
there is association of urban settings with traffic, frustration, congestion, stress, crime,
and pollution, which result in ones psychological desire to escape it.
He also introduced the concept of ‘framing of views’, engaging patients with
specific elements like water feature or a tree in the landscape, which allows for a
moment of self- awareness, that acts as a distraction from pain and suffering. This
concept also generates comfort and relaxation, which allows a patient to heal faster by
creating the perception of an environment, where patients view the external world
rather than being viewed by others, thereby moving away from the inherent qualities
of institutionalisation.
2.8 UNDERSTANDING THE STIMULATION OF HUMAN SENSES

Physical surroundings have a direct effect on our emotions and reactions that
essentially contribute to the process of healing within a space. The process of healing
is permitted by specific brain molecules formulating our ‘internal perception’, through
a combination of signals that enable our senses to perceive our environment. Our
emotional reactions to our surrounding unconsciously stimulate our immune systems
that essentially improve the process of healing.
World perception is formulated by nerve chemicals that control our mood balance,
while information received through the human senses ultimately formulates an image
of our perception of place. Our mood and health is an unconscious result of our
perception of place as our environment changes, so does our emotional response to it.
Technically, through the stimulation of certain brain molecules and chemicals with
certain spatial quality adjustments human emotions can be manipulated and change
personal moods positively to promote further healing.
Human senses can be perceived as the portal linking our emotions with our
perceived reality. Architecture can be described as the tailor of our sensual experience
of space, possessing the skill to deprive or stimulate the human senses. Architectural
phenomenological theories regarding spatial experience are mainly concentrated
towards the stimulation of all the human senses, in order to ultimately formulate an
intensified experience. Architecture can in many cases, be considered as a container of
human stimulation through the skill of its environment, by means of the senses,
namely touch, sound, smell and sight.
2.9 EFFECT OF LIGHT, SHADOW AND COLOR

Natural light and the sun’s rays are recognized as elements capable of promoting
curing and thus should form a fundamental part of the design of buildings constructed
specifically for rehabilitation. It is proven that patients exposed to an amplified
concentration of natural sunlight perceive less stress and requires less medication and
even experience less pain. Sunlight can also be perceived as a form of psychological
motivation in its utilization in the creation of a healthy, healing environment.
The balance or imbalance of a space can so easily be altered through the play of
light and always in combination with forms, colours and natural elements. The quality
of light can be manipulated and modified to ultimately create the ability of
transcending individuals into an alternate state of consciousness that could basically
be recollected in memory.

Figure 2.3:Colour wheel of emotional psychology
Colour psychology has also been identified as a tool capable of improving human
behaviour, moods and emotions. Both colour and architecture has the ability to
visually stimulate patients and the surrounding society, which can provoke and elevate
positive or negative emotions. These emotions are triggered through our mental
perceptions of colours in relation to the connection of these colours with certain past
personal events or cultural beliefs. Society’s emotional response to colour is based on
shared psychological associations of certain emotions to certain colours.
Thus architecture should include the power of colours into modern healing
environments to evoke and stimulate certain emotional responses and use it as a tool
to experience the space as preferred.
2.10PRINCIPLES OF HEALING ARCHITECTURE

According to Erik Asmussen’s architecture in Vidarklinikert, there are seven

principles while designing a healing centre.The seven principles of organic
functionalism define an approach to design that is capable of creating an architecture
that is nurturing, healing and alive. They are as follows:
1. Unity of form and function: In other contexts, it is known as spiritual
functionalism. It very consciously encompasses technological, psychological,
social, ecological, human and cultural/spiritual dimensions of function in an
architecture that speaks to the whole human being. The difference in mood
and functionality can be easily identified because everything from the light
fixtures to the colours, room shapes, and window proportions are designed to
image and accommodate what goes on there.
2. Polarity: This implies that differences are not merely oppositions, but that
differences are distinctions that are nondual part of a larger whole. Polarities
are always balanced within the embrace of a bigger and often trinitarian
whole.
3. Metamorphosis: This concept is, perhaps, the most important and the most
difficult principle to implement. These are the polarities that are generative
basis for the metamorphic processes that give rise to all the varied forms in
nature. Through a rhythmical series of expansions and contractions, nature
continually transforms itself.
4. Harmony with nature and site: the building is visibly shaped by and in
conversation with naturally occurring features such as trees and rock as well
as other buildings nearby. It should be in harmony with nature and site and
should take on characteristics that reflect qualities of the surrounding
environment.
5. The living wall: Most walls are substantial filters between structurally
repeating elements of a grid; they have neither identity nor character nor
anything that attracts people to them. But it should be living membranes that
reveal the play between the polarities of up and down, inside and outside.
6. The dynamic equilibrium of spatial experience: Primarily there are two kinds
of spaces- those for movement and those for rest. In the movement spaces,
there should be places for rest and in spaces for rest, which are typically
rooms for specific activities, there should be also a sense of movement.

7. Colour luminosity and colour perspective: Upon entering any structure, one
should be immersed in a world of light-filled transparent colour.
2.11SPACES FOR SOCIAL SUPPORT

Architecture needs to change and adapt its traditional perceptions of
institutionalization to create an atmosphere that stimulates all the human senses and
deviates from the past stigmatized approaches of institutional design. There is a need
to integrate rehabilitation into our city’s fabrics to be part of society, generating
community interaction and promoting a social environment. Healing architecture
should not create the notion of long-term absence from real life but should be
considered as a home away from home, a road that leads to social inclusion and
individual control.
A healing centre located within the heart of a socio-economic depressed
community will not just serve as a rehabilitation centre but also as a public
psychological retreat from the reality of everyday urban conditions. These transitory
social spaces should not promote the feeling of exclusion, but rather imitate a society
that embraces individuals through an environment that fosters measured community
interaction and gradual reintegration.
Social support in upcoming hospitals is encouraged through social interaction that
may vary in different levels and variation. The social interaction can be done through
informal meeting which we experienced in our daily lives and complete social
relationships like we experience in our home in safe and physically well being
surroundings. Through these actions social interaction will increase and knowledge
sharing and motivation with patient of equal status are potentially responsive. The
physical surrounding has potential to have ideal settings where common areas are
constructing both preliminary contact and developed social relationships. Usually
one’s everyday activities are performed with family and friends, while in the hospital
these simple familiar activities suddenly are occurring with unknown people in a
semi- public space.
If these social spaces are improved, then the healing power will also get increased
and may be considered as influential elements in regard to healing architecture.
• Homely atmosphere:

Home is defined by the anthropologist Mark Vacher as a connection between a

human being and a physical object. This object is generally a building, although more
primitive units also perform as homes with the same psychological characteristics. A
home is personal and intimate, and not something you can buy. Houses are not only
frames for people, people are framed by houses and the things they harbour, at the
same time as people project their own emotions, dreams and hopes onto the things and
the spaces that constitute the house.
When hospitalized, the family contact may be reduced and the environment today
is often characterized by institutional settings. Hence, the two aspects that form the
basis of this social communication and support in our everyday life are in fact not
present today. From architectural point of view it is very difficult to raise the visits in
patient’s room. Instead, other patient and staff can act as a family member at that point
of time may be even for better social support in some health related issues.
The homely atmosphere in hospitals and rehab centre may be difficult to define, as
our home is usually very personal and individual and therefore impossible to transfer
directly to a health care environment. However, it is possible, that by implementing
three fundamental characteristics of our home and everyday life, including functions;
materials and textures and details, it is possible to create a more homely atmosphere in
the social spaces, than we experience today.
• Functions:
Patient should have alternative between social and private space, ideally a gradual
change between them. Private spaces may appear in single room but a new concept is
needed to get complete framework of common spaces and dayrooms in the future
should appear social. This social aspect may derive from inviting, attractive and
socially obvious functions performed by patents and their families in the common
areas of the patent ward. Accordingly, the specific programming of the common
spaces is essentially important to design very deliberate.
Firstly, the inhabitants should engage acquaintances, through a process that may
be compared to the human interaction in public spaces or the small talks with our
neighbor in the front yard. Secondly, the patents should develop these initial
relationships, through deeper conversations and social interaction, which may cause
for more recognizable and familiar settings, reflected in the patents everyday life.

When considering the functions in the common spaces, these might actually be
quite parallel to the activities performed in our daily life and the planning of a patient
ward may even be compared to a regular single family house having rooms for:
conversations and drinking coffee in the living room, relaxing in the lounge area;
dining around the kitchen table; simple cooking in the kitchen; entertaining around the
television, etc. By introducing these social activities in new- designed patent wards,
and by making them elective and inviting for both patients and their families, spaces
for social interaction and support are said to have improved conditions.
• Materials and textures
Besides reflecting the everyday life through intended activities and programming
of the social spaces, materials and textures also have important influence on the way
we feel, act and interpret the room, and should reflect the familiar and homely
environments we are used to form our own house. The spaces often appear clinical
and institutional, with standard equipment and furniture, acoustic ceilings, white
plaster walls, etc.
As regards to social interaction, these spaces are predicted to limit the potential, as
the inhabitants will adapt their behaviour to the institutional surroundings with no
conclusive benefit for engaging social interaction and social support. Today human
qualities are challenging against hygienic standards and general call for durability and
the major challenge for the health care architect is therefore to balance between the
homely expression and the rational clinical demands, keeping in mind that the close
compromise may determine the success or failure of the spaces for social interaction.
• Details:
Small details may change our use and perception of any space rapidly, and if only
prioritized by the architect, spaces for social support may be improved significantly in
future hospitals and rehabilitation centre. First of all, the overall scale of the room
should be familiar in size and easy to overview if more personal conversations should
take place, and even in regards to dimension of furniture. Smaller tables will for
instance force the inhabitants to sit within their intimate distances, which may be
advantageous for deeper conversations and social support. However, if the inhabitants
do not know each other yet, the small table and intimate distance may be an
unconscious limitation for them to join an occupied table, and the patients will then
never engage important initial contact.
Seating environments along the perimeter of the room is usually preferred, where
the individual exposure is limited, and it is possible to create a comfortable overview
of the surroundings. Details in the orientation of the furniture may even define the
social status of the room, where a face-to-face layout facilitates a social behaviour and
the back-to-back arrangement is creating a private space.
2.12THE THEORITICAL APPROACH

HOW TO ACHIEVE SOCIAL INTERACTION AND SUPPORT
Appealing and attractive spaces for social interaction and support in future
hospitals are depended on the surrounding architecture and the detail of the physical
design, seems easily accepted through evidence- based decision makers, urban
planners and anthropologists if the environment is mot providing possibilities for
social activities, there will not be any interaction between patients-hence no social
support. The architectural effects are compiled in three guiding subjects, including
functions, materials and textures and details, their aspects are defined in regards to the
context of hospitals.
The theory described by Gehl (2003) and T.Hall (1973) states that people attracts
people, if the social area remains unattracted then the physical environment remain
empty all the time. When the patients or their families have engaged social interaction,
maybe through the attractive functions, they should develop these contacts, which call
for spaces recognizable from their own home, partly achieved through a mix of
functions- reflecting the everyday life. Following the ideas and theories of
anthropologists, the materials and textures should overall assist in creating a familiar,
sensory and homely atmosphere.
The final aspect considered as one of the main guidelines for future social spaces
are the details and interior planning in human scale, concerning scale, personal
distances and sociopetal spaces. Often small details change the way we experience a
room, and some of the main physical elements in today’s hospitals, like acoustic
ceiling sheets, integrated artificial lighting, vinyl flooring, etc. are only supported by
the details of for instance coffee serving, greenery, arts and furniture, all together
defining the social space as institutional, inhuman and basically unfit for social
interaction.
2.12.1FUNCTIONS
REFLECTING THE EVERYDAY LIFE

Usually there are uninspiring and unattractive spaces in hospitals which is not used
by the patient. Above all, patient should have preference between social and private
space, ideally a steady transition between them. Private spaces may appear in single
room but a new concept is needed to get complete framework of common spaces and
dayrooms in the future should appear social.
The patients should engage acquaintances, through a process that may be compared
to the human interaction in public spaces or the small talks with neighbour in the front
yard. In a future patient ward these informal meetings may occur in the common
dayroom or even in natural flow intersections and recesses along the hallway.
Secondly, the patients should develop these initial relationships, through deeper
conversations and social interaction, which may cause for more recognizable and
familiar settings, reflected in the patients’ everyday life.
When considering functions in the common spaces, these might actually be quiet
parallel to the activities performed in our daily life and the planning of a patient ward
may even be compared to a regular single-family house having rooms for;
conversations and drinking coffee in the living room, relaxing in the lounge area;
dining around the kitchen table; simple cooking in the kitchen; entertaining around the
television, etc. By introducing these social activities in new- designed patient wards,
and by making them optional and inviting for both patients and their families, spaces
for social interaction and support are believed to have improved conditions in future
hospitals.
2.12.2MATERIALS AND TEXTURES

FAMILIAR AND HOMELY ATMOSPHERE
A deliberate choice of materials for any room, i.e. the visual surface and the
physical perception, are often under prioritized in many projects, and in health care
architecture, the high demands for hygiene, cleaning and durability are usually crucial
factors when considering materials in both bedrooms and common areas.
Consequently, the spaces regularly appear clinical and institutional, with standard
equipment and furniture, acoustic ceilings, white plaster walls, etc.
As regards to social interaction, these spaces are predicted to limit the potential, as
the patients will adapt their behaviour to the institutional surroundings with no
conclusive benefit for engaging social interaction and social support. Today human
qualities are challenging against hygienic standards and general call for durability and
the predominant challenge for the health care architect is therefore to balance between
the homely expression and the balanced clinical demands, keeping in mind that the
close compromise may determine the success or failure of the spaces for social
interaction.
2.12.3DETAILS
INTERIOR PLANNING IN HUMAN SCALE
Small details may change our use and perception of any space rapidly, and if only
prioritized by the architect, spaces for social support may be improved significantly in
future hospitals. First of all, the overall scale of the room should be familiar in size
and easy to overview if more personal conversations should take place, and even in
regards to dimension of the furniture. However, if the patients do not know each other,
the small table and intimate distance may be unconscious limitation for patients to join
an occupied table, and the patients will then never engage important initial contact.
The design of details and furniture should therefore contemplate the intended social
concept in the common areas. Seating environments along the perimeter of the room is
usually preferred, where the individual exposure is limited, and it is possible to create
a comfortable overview of the surroundings. Details in the orientation of the furniture
may even define the social status of the room, where a face-to-face layout facilities a
sociopetalbehaviour and the back-to-back arrangement is creating a sociofugal, private
space. Ideally the patient ward should provide both private spaces, passive
observational spaces and social spaces, although not necessarily in the same room.
Today, details like light fittings, acoustic regulators, blankets, cushions and other
equipment are all details. However, by bringing focus to these significant details as
well, the future design for social spaces may become a holistic design solution
creating a homely and inspiring atmosphere promoting social interaction and support.
2.13HOW TO ENHANCE SOCIAL ATTRACTION

2.13.1 PUBLIC SPHERE ENVELOPES THE PERSONAL SPHERE
Giving the possible privacy with some social spaces are necessary and are stated as
a basic qualification of rapid recovery. But constant withdrawal and always keeping
oneself to oneself so as to be spared social contacts and confrontations is often one of

the symptoms of mental illness, and so care is concerned with developing the patient’s
social capacity.
The social element also has to be gradually increased, but of course depending on
individual situations. The design of the physical environment, accordingly, must
support the individual patient’s gradual expansion of his personal sphere, from
patient’s own bed to open door to green or entering to another patient room and sitting
down to such social well being corner to talk. All these activities get used to patient
daily lives which never make them felt that they are hospitalized or increasingly
widening the social context.
In Pune “Mukthangan De-addiction centre” observed that patient rooms are placed
near the amphitheatre space near the natural elements like trees, sunlight and gentle
wind to heal their agitation. The language of making public activity inside the private
spaces are done also in Mukthangan rehabilitation centre with the help of well
litamphitheatre space in the centre enclosed by rough wall to give those agitated
people a sense of protection.
• Social participation and elective seclusion
• Successive expansion of the personal sphere
• Parts with different degrees of seclusion and publicity
• Secure and intimate seating areas on the fringes of the public zone
2.13.2 CALL FOR SOCIAL SUPPORT

The call for social contact between individuals is a concept that covers many
different variations, from simple unpretentious contacts to more complex and
emotional conversations and intercourse. The public space mainly represents the
casual and passive kind of contacts, which compared to the more powerful contacts
are considered modest. However, they still possess great quality and worthiness, as
autonomous contact, or as basis for more developed kind of contact.
For instance, as maintenance of existing relationships, and especially as inspiration
of acts and activities, that other people are performing. If this basic social contact is
not obtainable, the boundaries between isolation and social contact are too
pronounced, and you are either alone or in binding connection with others. The social
contact on the low intensity scale is therefore an evident and important possibility for

persons to interact with others on a casual level, and perform as transition between
various kinds of contacts.
The establishment of such common attractive and inviting social spaces is very
much required for day meeting to interact socially patient with equal status for social
support which enhances their knowledge about such situation.
2.13.3 ACTIVITIES IN THE PUBLIC ZONES

There are basically three types of activities in public zones: essential activities,
optional activities and social activities- all with different demands to the physical
environments. The important activities which are performed they are in spite of of the
physical planning of social environment, they are not in contact to such areas, this
may be the medical treatment.
The optional activities are generally those activities which are done when they are
desired and these activities are only seen if the physical environment is in proper
condition. In respect to this elective activities are common facilities, relaxing walk,
informal conversations, etc. however, if the public or the social space is not in proper
condition then only necessary activities will be there.
2.13.4 SOCIOFUGAL AND SOCIOPETAL SPACES

Some types of spaces, for example waiting rooms in train stations had the ability to
keep people apart; while French cafes did the opposite and made people take on
interaction. The arrangements that discouraged social interactions were defined as
sociofugal spaces and the spaces that encourage and enforce the development of
interpersonal relationships as sociopetal.
Layout of furniture plays a very important role in enhancing the social interaction
suppose if the chairs are placed back to back then the place automatically turned into
sociofugal spaces. However, if the layout of the chairs is immediately changed they
are face to face then the space changes to sociopetal spaces. In some cases the
sociofugal setting would be preferable, for instance when studying or reading, and
what is considered sociofugal in one context might even be sociopetal in another
situation depending on the occurring activity and the people involved.
2.13.5 DETAIL DESIGNING

In regards to the human contact in public spaces, this is best unfolded on the
horizontal level, where it has a rather large area of function. On this level, the social
visual field is capable of intercepting other person’s features and mood in distances up
till 20 meters, and in shorter distances (1-3 meters), where we normally perform social
conversations, our visual senses are supplemented with other senses in order to form a
general impression of the person we are talking to.
The social activities have its own self-prevailing effect, where human actions
attract attention and thereby more people. The use of benches is depending upon their
orientation, where those situated where more human activities are done neither in
quiet green environment. As well as the sizes of furniture the orientation and layout
also have significant importance in regards to use and social interaction.
2.14GOALS AND BENEFITS OF HEALING ARCHITECTURE

The goal of healing environments is to engage patients in the process of self
healing and recovery. As a result, these spaces are planned to be nurturing and
therapeutic to decrease patient and family stress. In order to encourage recovery,
healing architecture aims to:
• Eliminate environmental stresses, such as noise, lack of privacy, poor air
quality and glare.
• Connect patients to nature by giving outdoor views and other natural
features, including interior gardens and water elements.
• Improve the patient’s feeling of being in control by offering options and
choices- these may contain privacy versus socialization, lighting level, type
of music and quiet versus active waiting areas.
• Encourage opportunities for social support, such as providing appropriate
seating in patient room, privacy for small groups and overnight
accommodations in rooms.
• Provide positive distractions, such as interactive art, fireplaces, aquariums,
internet connection, music, etc.
• Motivate feelings of peace, hope, reflection and spiritual connection.
Recent examples have shown how considerate architecture and design focused on
promoting healing can have a assessable impact on patient recovery, including shorter
hospital stays, fewer infections contracted in the hospital and reduced pain. Research

by Dr. Roger Ulrich, a professor of architecture at the Centre for Healthcare Building
Research at Chalmers University of Technology in Sweden, found that gallbladder
surgery patients assigned to a room with a window view of a natural setting had
shorter postoperative hospital stays as compared to patients in similar rooms with
windows facing a brick building wall.
Healing architecture can also include strategies intended to reduce the spread of
disease. A recent trend in the healthcare industry is to grade hospitals based on the
likelihood of a patient incurring an infection in the facility that is different from the
medical issue for which the patient was admitted.
2.15HEALING SPACES IN DE-ADDICTION CENTRES

As a response to the current state of modern hospitals and as a weighty tool in
future health care settings, the term healing architecture has gain ground. Thus the
importance of architecture in hospitalization which reduces the healing period through
its various spaces as given below:
1. Homely atmosphere-
• Authentic healing modalities
• Individual process
• Spiritual guidance
• Spa and anti-stress treatments
• Workshops
• Yoga centre
• Meditation centre in nature
• Architecture should be in relation with natural built environment.
2. Connection to nature-
• Nature window views
• Garden accessible to patients
• Nature art
• Daylight factor
• Internal courtyard connected to ward, patient room
• Quiet in CCU
• Music during minor surgery
• Air quality

• Landscaped courtyard
• Floor to ceiling windows
• Landscaped setback
• Front porch
• Entry garden
• Plaza
• Roof terrace
• Walk in garden
• Sound of water and attraction of birds to the fountain
• Roof gardens for mood changes
• Wide walkways outside patient rooms provide a buffer from garden
activities
• A covered patio style coffee shop provide and shelter for an outdoor
eating area within a garden
3. Social structure-
• Green lawn for social improvement in structure
• Imaginative maze for children
• Covered sitting terrace or patio within a nature surrounding
• Single occupancy vs. multi occupancy patient room
• Elements in the social dayroom.
2.16SURVEY
2.16.1INTRODUCTION
This chapter includes the information collected from the inmates of Suraksha de-
addiction centre, Calicut as a part of the survey. The survey was done with almost 10
inmates of the de-addiction centre on the need for healing gardens inside the centre.

2.16.2DATA COLLECTION
1. When you are not engaged in medical therapy or other planned activities, how
much time do you spend in the garden?
A. All my free time
B. Only the time for a cigarette or a chat
C. When I have relatives or friends visiting
The majority of patients between 20 and 30 years of age and those between 51 and 60
use the garden for only a few minutes. Patients aged between 31 and 50 years of age
and older patients use the garden mainly during visits by relatives, from 1.30 to 2.30
pm (Monday-Friday) and from 2.30 to 6.00 pm (Saturday and Sunday). There are no
restrictions on the number of relatives admitted, although there is usually one or two
per patient. For this reason in the design phase it is important to provide facilities to
accommodate visitors and patients.
2. What kind of feelings do you have when you are in the garden?
A. Positive (tranquility, relaxation)
B. Negative (loneliness, abandonment)
C. No special feeling
Most patients have positive feelings but some experience loneliness. It is important to
provide quiet areas for privacy but also areas for socializing.
3. What do you think is the most pleasing feature of the garden?

A. Seeing plants and flowers
B. Smells and sounds of nature (wind rustling, birds chirping ...)
C. The possibility of being outdoors
D. The light and warmth of the sun
E. The sense of peace

The majority of patients enjoy the chance to be outdoors. At present the planned
activities performed in the garden under staff supervision are board games, card
games, table tennis and football, and the garden is mainly used for meeting relatives.
The design must contemplate the possibility of transferring other rehabilitation
activities and related facilities into the garden.
4. Would you like to do any activities in the new garden other than those already
available?
A. Taking long walks
B. Physical exercise outdoors
C. Having quiet areas to sit and read away from noise
D. Growing flowers
E. Growing vegetables
F. Having quiet areas to chat with relatives and friends
Many patients would like to walk, grow flowers and plants and have secluded areas
for talking with relatives.
5. What improvements would you make in a new garden compared with the current
one? A. Make flowerbeds
B. Increase the space available for walking
C. Increase seating
D. Eliminate perimeter wall
E. Create lawn areas for sitting or lying down, and for walking barefoot
F. Create an area with water (a fountain or a pond with fish and aquatic plants)
G. Include an area for small animals
In accordance with the needs of the patients, ornamental and quiet areas, footpaths,
areas for growing flowers and areas for private talks should be planned.
2.16.3CONCLUSION
Based on the survey done, the following conclusions were made:
• Most of the people use the gardens for meeting relatives and gaming.
• Green spaces in the planning provide positive energy to the patients.
• Areas such as small ponds and areas for pets should also be included as this
adds to the mental health of the inmates.

2.17QUESTIONNAIRE
FOR DOCTORS
1. Do you think that a green space inside the hospital would reduce the
stress and anxiety in the inhabitants?
2. How would you like to use the free spaces in the hospitals effectively?
3. Will incorporating green spaces affect the inhabitants negatively in any
aspect?
4. Does the involvement of families and friends in de-addiction centres
help the inhabitants to reduce the stress?
5. Will the colours, materials and textures of walls, ceiling and flooring
affect the inhabitants psychologically?
6. What kind of colours do you find will work best in such spaces?
Warm/ cool colours?
7. Do open and semi-open designs help in better curing?
8. Any concluding remarks concerned with this topic?
FOR PSYCHOLOGIST
1. What would you like to see in a drug rehab centre for the future?
2. Does the involvement of families and friends in de-addiction centres
help the inhabitants to reduce the stress?
3. What do you hope the design would do?
4. What areas of the healing environment should be focused on?
5. Will the colours, materials and textures of walls, ceiling and flooring
affect the inhabitants psychologically?
6. Any concluding remarks on this topic?
CHAPTER 3
3.1 INTRODUCTION
The ultimate goal of rehabilitation is to restore to normal life. Rehab can be used to
help a recover from addictions, injuries and even physical or mental illness. Drug
rehab can only be truly effective when the patient has the desire to be there and to

change his or her addictive habits. Once an individual gets through the initial detox
from drugs or alcohol, they will move on to the rehabilitation portion of the recovery
process. This is where the patients get to the core reasons behind their addictions,
addressing those issues so they can effectively move on with their lives without going
back to drugs, alcohol or their addictive behaviour. The length of time a patient spends
in a rehab facility depends on his or her healing process.
The study focuses mainly on creating healing environments in de-addiction centres
by incorporating nature with the design. For this, three literature case studies are done
on healing environments and a live survey is done with the patients and doctors of de-
addiction centre in Calicut. The literature case studies include the Fortis
hospital,Medicity in Gurgaon, India and rehabilitation centre Groot Klimmendaal. The
survey is done with the patients, doctors and the counsellors at the Suraksha drug de-
addiction centre, Calicut, India.
This research focus on recovery of the patient which reduces the rehabilitation time
which in turn reduces the stay time in hospitals. The research intends to change the
mind of the designer and improve the designing techniques used by the architect in
designing a hospital. This chapter comprises of a small introduction on each case
study, reason of the study and the detailed analysis on the planning principles of each
of the health care centres.
3.2 FORTIS HOSPITAL, GURGAON

Figure 3.1: View of Fortis Hospital, Gurgaon
3.2.1 INTRODUCTION
LOCATION: Gurgaon, Haryana
SITE AREA: 43,303 sq.m.
ARCHITECT: Ar. Rajinder Kumar, New Delhi
Fortis hospital is a multi specialty hospital in a 11 acre land with 430 functional
beds. The main facade of the building is facing north-west direction and the service
areas are provided in the south-east direction. The atrium in the centre of the building
is receiving diffused light from north direction. Healing gardens are provided in the
north side so that it is shaded all the time from the sun rays. Heavy plantation is done
along the site boundaries to absorb most of the noise coming from the vehicles
outside.
3.2.2 REASON FOR THIS STUDY

The main reason for choosing this hospital as a case study is it's main aim to create
an environment which should not give a sense of boring hospital. The design
philosophy behind this hospital to provide the health and well being of the people they
serve through integrated, innovative and compassionate care, also creates spaces that
allows privacy, rejuvenation, choice, humanistic scale, feel and experience,
communication and collaboration. At the south corner is a quiet and sun filled healing
garden for patient and areas for staff and families. All the major areas in hospital have
natural light for healthy and sustainable environment.
The architecture of this hospital considered the healing source, although factors
like sunlight, room atmosphere, sound, music, art and optional privacy altogether are

believed to assist in creating such environments which supports the physical and
psychological healing of the patients.Almost all the major spaces and waiting areas
has natural light penetration, transmitted from the skylight above. The integration of
natural physical environments into treatment has always proven to be effective.
3.2.3 HEALING CHARACTERISTICS

a) PLANNING
When one faces a stressful challenge or situation, the person will have the ability to
seek meaning in it, and will do his or her
best to overcome it. The following are
some design characteristics which help in
enhancing the sense of coherence among
the patients, staff and visitors:
Figure 3.2: Fortis hospital- lobby area

• modular planning of clinical
floors to optimize flexibility
• Clear organization and simple circulation systems with medical areas eases
patient and staff use.
• It has flexible floor plates which provide shared practice space,systems
andamenities for various clinical modules.
• The hospital also accommodates a small cinema for visitors, so that they will
feel stress free.
Figure 3.3: Interior

of Fortis hospital
The experience starts when one enters the lobby area, where a welcoming fountain
sculpture and reception welcomes the visitor with a holistic approach. There is a white

sculpture titled 'Lovable curious child'- a baby with a stethoscope plugged in. Features
such as operable windows or access to sporting facilities make a significant difference
in the level of one’s perspective.
The patients’ required less narcotic pain medication experienced a shorter hospital
stay and had fewer negative evaluative comments. The natural light penetration in the
atrium space makes this more effective. Almost all the major spaces and waiting areas
has natural light penetration, transmitted from the skylight above. The integration of
natural physical environments into treatment has always proven to be effective.
Elements in the nature emulate qualities of calmness and serenity that are necessary
for healing environments. Open windows provide daylight and view, which are two
important factors of healing environment.
Landscaping at the entrance gives the patients and the visitors a sense of order,
decreases the stress and the anxiety among themselves. It also provides a sense of
supportive design for patients as plants represents life, growth and hope.
b) MATERIALS AND TEXTURES
The red colour broad strip dominating in the central courtyard is a sound absorbing
material which reduces the bad noise, enhances the healing power.
3.3MEDICITY, GURGAON

Figure 3.4: Medicity, Gurgaon
3.3.1 INTRODUCTION
LOCATION: Gurgaon, Haryana
SITE AREA: 43 Acres
ARCHITECT:Cardinal Hardy architects
Medicity is a world class 1,200 bed hospital with 10 super specialities, 40 high-
tech, air-conditioned surgical amphitheatres equipped to perform robotic surgery, and
much more. It has a built up area of 15, 00,000 sq.ft.

The design philosophy behind the hospital to provide the health and well being of
the people they serve through integrated, innovative, and compassionate care, also
creates spaces that allow for privacy, rejuvenation, choice, humanistic scale, feel and
experience, communication and collaboration.
The architecture of this hospital considered the healing source, although the factors
like daylight, room atmosphere, sound, music, art and optional privacy, altogether are
believed to assist in creating carefully designed environments that affects and supports
the psychological and physical healing of the patients.

There is a healing garden in the fifth floor level, which is enclosed between the
buildings. It acts as a central
green court or a healing garden
for the patients to increase
common activity arouses the
sense of coherence among the
patients and the staff.
Figure 3.5: Medicity-Lobby area

a) PLANNING
The architecture of a healing environment can take on the qualities of natural
conditions through imitation in form. While one must feel constrained and boxed in
rectilinear spaces, the fluidity of an organic space creates no such feeling. Without
right angles, the space becomes seemingly less harmful and comforting to human eye.
The Medicity come up with design solution to give natural views to visitors
waiting area and lounge area through floor to ceiling windows. It is evident that
visitors have views of nature which symbolises calmness and peace. Outside the
building there is also an assembly area for visitors where visitors walk and talk with
each other, in term increase the social support among them.
Green entrance and landscaping in a systematic pattern arouses a sense of control
among the patients and visitors, which realises the patient a sense of security
ultimately increases the coherence factor among the staff and the patients. The
building is oriented in the north-south oriented. The building has two big bed towers
which are interconnected with one central arm. The two bed tower enclosed a green
area in between which is having shaded area due to south-east block. The bedroom on
outer side of the south-east block get ample amount of daylight while the inner face is
in shaded region, on the other side north-west block getting the west sun in the inner
side while the outer side is in the shaded region.

Figure 3.6: Medicity- OPD section

b) GREEN ENVIRONMENT
Healing landscapes have long been an important aspect of human life. When
people first began erecting dwellings, healing places could be found with in nature
through sacred groves, special rocks and caves.
3.4 REHABILITATION CENTRE GROOT KLIMMENDAAL
Figure 3.7: Rehabilitation centre Groot Klimmendaal

3.4.1 INTRODUCTION
LOCATION: The Netherlands
SITE AREA: 14,000 sq.m.
ARCHITECT: Architectenbureau Koen van Velsen BV
Rehabilitation Centre Groot Klimmendaal was awarded Building of the Year 2010
by the Dutch Association of Architects, winner of the first Hedyd’Ancona Award
2010 for excellent healthcare architecture, winner of the Arnhem Heuvelink Award
2010 and winner of the Dutch Design Award 2010 public award and category
commercial interior. It brings together transparency, diversity, continuity, the play of
light and shadow, colour psychology and the experience of nature into a stimulating
revalidation centre.

Located in a serene Dutch forest, the Rehabilitation Center Groot Klimmendaal by
Architectenbureau Koen van Velson was among six projects shortlisted for the 2011
Mies Van Der Rohe Award, the European Prize for Contemporary Architecture. Inside
are clinics, offices, sports facilities, a swimming pool, a restaurant and a theater. With
reflective glass windows and neutral anodized aluminum cladding, the building is
meant to blend into its natural surroundings. The design stresses natural light and the
healing power of connection to the outdoors.
Revalidations centre “Groot Klimmendaal’ is a coming together of both complexity
and simplicity with attention for physical, practical and social details. Transparency,
continuity, layering, diversity, the play of light and shadow and the experience of
nature are all ingredients of this stimulating environment.

a) PLANNING
Full height glazing along the central space connecting the various different internal
elements of the building ensures continuity between interior and exterior. The
meandering facade in the restaurant results in a building in between trees and invites
the forest inside the building. The surrounding nature has a strong visual and tangible
presence everywhere in the building; it allows the user to revalidate whilst walking.
The arrangement of the programme is clear. Below are offices, above are the clinical
area’s and on the roof a Ronald McDonald House with its own identity.
The double-height ground floor at entrance level facilitates the special elements of
the programme such as a sports facility, fitness, swimming pool, restaurant and
theatre. Not only patients but also family members and members of the local
community (schools, theatre groups etc) use these facilities on a regular basis. As a
result, both patient and building are placed at the centre of the community. The health
care concept is based on the idea that a positive and stimulating environment increases
the well-being of patients and has a beneficial effect on their revalidation process. The
design ambition was not to create a centre with the appearance of a health building but
a building as a part of its surroundings and the community.
Figure 3.8: Power of windows Figure 3.9:Colour schemes
Revalidation centre ‘Groot Klimmendaal’ radiates self-confidence and self-control.

The welcoming and open environment offers a natural habitat for care but at the same
time allows plenty of opportunity for other activities. The building is the result of an
intensive collaboration between architect Koen van Velsen and the users of the
building. For example, a shallow timber staircase runs the full internal height of the
building and is typical for the new integral way of working. It facilitates a direct route
between the different floors but also enables a variety of alternative routes roaming the
building and thus forms an invitation to undertake physical exercise. A combination of
large and small voids and light wells ensure a spatial connection between different

levels and allow natural daylight deep in the heart of the 30metres wide building.
Interplay of striking but subtle colours and direct and indirect (artificial) lighting
enlivens the interior.
b) SUSTAINABILITY
The use of energy is amongst others reduced by the compact design of the building
and the design of the mechanical and electrical installations. Most notably the thermal
storage (heat and cold storage) contributes to the reduction of energy consumption.
The choice of selecting sustainable building materials and materials requiring little
maintenance for floor finishes, ceilings and facade cladding result in a building which
can be easily maintained and with a long lifespan. The building has been custom made
for its users but the design offers at the same time opportunities for different ways of
using the building and the inevitable transformations of different departments within
the client’s organization. The building maintains a transparent connection with its
natural surroundings, blending interior and exterior and maintaining a strong natural
presence throughout the building; which allows patients to rejuvenate even while
walking. Light wells and atriums are used in combination to bring natural light in and
to create visual connections between levels. The interior also includes subtle
interplays of colour in combination with natural and artificial lighting to enliven the
space.
Figure 3.10: Groot rehabilitation centre
3.5PSYCHIATRIC CENTRE REICHENAU

Figure 3.11: Psychiatric centre Reichenau
3.5.1 INTRODUCTION
LOCATION: Reichenau, Germany
SITE AREA: 3274 sq.m.
ARCHITECT: Huber Staudt Architects
The new psychiatric centre with 1 to 3 storeys fitted into the existing slope takes up
the orthogonal structure of the hospital Friedrichshafen, thereby turning into an
element within the "campus" structure. The building encloses a generously
dimensioned green courtyard that follows the natural slope of the hill and forms
toward the west a window to the landscape and to Lake Constance.

The positioning of the building at the junction of an earlier historical road
connection to the chapel means that the building naturally fits into the historical
structure of the complex. It marks the entrance to the campus. The open building with
its contemporary design clearly shows the process of further development and renewal
of the psychiatric centre Reichenau to the outside.

Figure 3.12: Exterior view

a) PLANNING
The new psychiatric centre lies embedded into the campus
of Friedrichshafen Hospital and follows the picturesque, orchard-laden, natural slope
of the hill towards Lake Constance. The building encloses a generously dimensioned
green courtyard and exploits typologically the contour of the hillside by providing
entrances on two different levels. A wide spanning bridge frames the generous view
into the undulating landscape and helps to emphasise the natural slope even within the
sheltered courtyard. The psychiatric centre can be easily perceived from the landscape
while enabling picturesque views of the countryside from within. Large
central therapy rooms with direct access to the patients´ garden are arranged on the
lower floor by exploiting the possibilities of natural illumination along the slope.
The main building of the hospital, constructed in the 1960s, dominates the
extensive grounds of the campus. The adjacent singular buildings of both the
Kindergarten and the residential developments relate orthogonally to the hospital. The
proposed expansion of the campus through the Mother-Child Centre, the Medical
Centre and the Radiotherapy Centre emphasise in their orientation the pedestrian-
friendly character of the campus. The new Psychiatric Centre arranges itself as a
significant figure in this system. The entrance area between the new build and the

existing hospital provides a high level of amenity and invites patients, visitors and
employees of the hospital to linger.
Figure 3.13: Interior courtyard
b) MATERIALS AND TEXTURES

The two materials, fair-faced concrete and untreated wood, dominate the surfaces
of the building both internally and externally. Concrete is treated in a sophisticated
way: large flat board-marked concrete surfaces and fine horizontal linear prefabricated
elements, corresponding with the vertical fins of the wooden cladding. The timber
cladding is made of untreated silver fir as a reference to the local building tradition,
particularly in the nearby Vorarlberg region of Austria. The vertical cladding,
comprised of untreated wooden profiles, lends the building, through its transparency,
an airy and open appearance.
Figure 3.14: External cladding

CHAPTER 4
4.1 INFERENCE
From the above case studies and literature studies, it is evident that nature plays a
major role in healing.All the examples of drug de-addiction centres till now advocate
the isolation of people from society with the intention of replacing the undesirable
distractions associated with an urban lifestyle with the desirable effects of the rural
one, which is believed to increase the healing effect.
The ability of architecture to heal the mental and physical illness with the different
planning parameters and the elements that can enhance healing has been explored.
Without compromising on the need, the ability of all patients to be outdoors in a good
and calm environment is the greatest strength. In exploring art as healing, architecture
as an art and lastly, architecture as a healing space, it can be observed that the
common bond between them is that art does have healing qualities and it can be said
that such healing qualities provide therapeutic effect in one’s life.
These studies have brought about key design objectives that may be crucial in
space making concepts for healing architecture in rehabilitation centres. The purpose
of creating a green oasis, through which patients can retreat to unescort by staff, has to
be achieved. Even in a number of problems where the outdoor environments are
concerned, everyone agrees that the existence of green gardens and light courts is
something positive and is good for patients. It is also clear that being allowed out in
the gardens is perceived as conferring an opportunity of greater sovereignty.
In the design process, the architect should consciously reduce the institutional
ambience and create such designs which will shift the pathogenic approach. There is
scope for the patients to use different parts of the environment, both indoors and
outdoors depending on the stage of the recovery process they have come to. Outdoor
spaces are always with lusting green and the sound of water to heal their agitation.
Indoor is more towards the sunlight that enhance the healing and the ventilation to
give the patient high level of conformability.

4.2 CONCLUSION
Considering and analysing the case studies along with the literature studies, there
are various connections that should be taken into account while designing a
rehabilitation centre. They include:
• The connection with personalized environment- homely atmosphere is one
of the important aspects to be considered while designing. The physical
space however is one that must be comfortable and a reflection to oneself.
The physical environments have a great influence on our social activities
promoting social support.
• The connection to sensory experience- the integration of all the senses
helps complete the highest potential of an environment to allow for
healing to emerge. The symbiotic relationship that exists between the two
is one that has to be nurtured.
• The connection with light- natural sunlight kills harmful bacteria and
cleans air. Apart from these obvious natural benefits of sunlight, natural
light- when controlled gives a space character that is sensual so giving a
space an emotive quality which can be felt by the end user.
• The connection with the city- the urban environment is harsh and busy and
tends not to offer many spaces or places of retrospection and
contemplation. The site should be a part of the city from detached from the
first pace. The end user should be able to arrive conveniently with public
transport to the site to allow a large catchment of people seeking a place
for healing.

GLOSSARY
• Healing architecture- describes a physical setting that supports patients and
families through the stresses that develop as a result of illness, hospitalization,
medical visits, the healing process or bereavement.
• De-addiction centre- process of medical or psychotherapeutic treatment for

dependency on psychoactive substances such as alcohol, prescription drugs,
and street drugs such as marijuana, cocaine, heroin or amphetamines.
• OHE- Optimal Healing Environment- a healthcare system that is designed to

stimulate and support the inherent healing capacity of patients, families, and
their care providers.
• Colour wheel of emotional psychology- illustrates the various relationships

among the emotions.There are eight basic emotions: joy, trust, fear, surprise,
sadness, anticipation, anger, and disgust.
• Harrison act (1914)-The Harrison Narcotics Tax Actwas a United States

federal law that regulated and taxed the production, importation, and
distribution of opiates and coca products. The act was proposed
by Representative Francis Burton Harrison of New York and was approved on
December 17, 1914.
• EBD- Evidence Based Design- the deliberate attempt to base building

decisions on the best available research evidence with the goal of improving
outcomes and of continuing to monitor the success or failure for subsequent
decision-making.
• Polarity- an integrated system that utilizes bodywork, awareness counselling,

diet, and exercise as parts of a comprehensive approach to healing.

• Social interaction- an exchange between two or more individuals and is a

building block of society. It can be studied between groups of two (dyads),
three (triads) or larger social groups.
• Sociopetal spaces- spaces designed to bring people together.
• Sociofugal spaces-spaces designed to minimise contact between people.
• Social support- the perception and actuality that one is cared for, has
assistance available from other people, and most popularly, that one is part of a
supportive social network.
• Fatigue-extreme tiredness resulting from mental or physical exertion or

illness.
• Stress-a state of mental or emotional strain or tension resulting from adverse

or demanding circumstances.

BIBLIOGRAPHY
• https://www.slideshare.net/DipeshAnand1/healing-architecture-for-hospital
• Architectural healing environments theses by Brian Schaller
• New design technologies: Healing architecture- a case study of the

Vidarkliniken. From: journal of healthcare design; proceedings from the eighth
symposium on healthcare design; Volume VIII, July 1996.

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DE-ADDICTION CENTRES: CREATING

Dissertation submitted in partial fulfillment of the requirement

Prof. N Ramaswamy Vani Pradeep

ThangalKunjuMusaliar College Of Engineering

Certified that this is a bonified record of the

in partial fulfillment of the requirements for the

of the University of Kerala

External examiner Internal examiner

Department of Architecture, TKM Page 2

I hereby declare that dissertation named De-addiction centres: creating healing

Kollam Vani Pradeep

Department of Architecture, TKM Page 3

Finally, I express my sincere gratitude to my family members and parents for

Department of Architecture, TKM Page 4

Department of Architecture, TKM Page 5

Chapter 2- LITERATURE STUDIES

Department of Architecture, TKM Page 6

2.13.1 Public sphere envelopes the private sphere………………………………32

Chapter 3-CASE STUDIES

Department of Architecture, TKM Page 7

Chapter 4- ANALYSIS AND INFERENCE

Department of Architecture, TKM Page 8

Figure 2.1- OHE: Optimal Healing Environments by Terri Zborowsky……..……..15

Department of Architecture, TKM Page 9

Creating a healing environment encompassing a wide range of factors from

Department of Architecture, TKM Page 10

There are a number of aspects to be considered while designing a de-addiction

It is intended to identify potential areas on the physical aspects of healing

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Department of Architecture, TKM Page 12

2.2HISTORY AND DEFINITION

2.3ROLE OF HEALING ARCHITECTURE

Figure2.1: OHE- Optimal Healing Environments by Terri Zborowsky

Department of Architecture, TKM Page 15

2.5NEED FOR HEALING ARCHITECTURE

2.6EVIDENCE BASED DESIGN

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effect on people bringing psychological reactions such as irritation, fatigue, inattention

2.6.3RELATION TO OUTDOOR AREAS

Department of Architecture, TKM Page 19

2.6.4PERSONAL AND SOCIAL SPACE

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The indoor climate, comprising thermal as well as atmospheric conditions, has a

Views and access to nature relieves stress and pain.

Good daylight quality, min. 500 lux, creates a good

Clear plan, visible entrance and good overview make

Private spaces improve confidentiality and relieve

Low internal noise level improves confidentiality and

Figure 2.2: Indoor climate and their effects

2.7 NATURE AS THERAPY THROUGH ARCHITECTURE

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2.8 UNDERSTANDING THE STIMULATION OF HUMAN SENSES

2.9 EFFECT OF LIGHT, SHADOW AND COLOR

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Figure 2.3:Colour wheel of emotional psychology

2.10PRINCIPLES OF HEALING ARCHITECTURE

Department of Architecture, TKM Page 24

According to Erik Asmussen’s architecture in Vidarklinikert, there are seven

Department of Architecture, TKM Page 25

2.11SPACES FOR SOCIAL SUPPORT

Department of Architecture, TKM Page 26

Home is defined by the anthropologist Mark Vacher as a connection between a

Department of Architecture, TKM Page 27