Positive environments can remove symptoms of severe mental illnesses, says architect and professor Jan Golembiewski. In an interview, he reflects on designing for mental illness and how this perspective could contribute to designing everyday environments that support mental well-being. Could re-designing our everyday environments be a cure for the globally rising mental health issues?
The burden of depression and other mental health conditions is on the rise globally, says the World Health Organization WHO. In 2010, mental illnesses and substance use disorders were responsible for 175 million years lived with disability worldwide, states International WELL Building Institute IWBI. It is also estimated that the life expectancy among those with mental illness is more than 10 years shorter than among healthy people.
Mental illness — as any other kind of illness — is a personal tragedy, but mental well-being is not only a question of an individual’s comfort. Instead, it is a highly charged economic and political question as well. For instance, at workplaces, mental disorders increase absenteeism and healthcare costs and decrease motivation and productivity. Investing in treating mental illness pays off — according to WHO, every US dollar invested in treatment for common mental health illnesses such as depression and anxiety leads to a return of 4 US dollars in better health and ability to work.
Reasons for the rising mental disorders are complex, but the finger often points to our lifestyles: constant busyness, flood of information and intense use of digital devices; pollution, nutritional choices, our everyday soundscapes — and the list goes on. What is common to these attributes is that they are all related to our everyday environments.
The environmental perspective is one of the rising interests in preventing and treating mental disorders. Most of our everyday environments are designed, which potentially lays urban planners, architects, designers and decision-makers a heavy responsibility on human well-being — more than what we have learned to think about.
One of the pioneers of designing environments that positively contribute to mental health is Sydney-based architect and professor Jan Golembiewski, the founder of architectural practice Psychological Design. His studies have shown the neurological mechanism on how the quality of external — environmental — stimuli impacts the symptoms of the severely mentally ill. Designing positive environments for the mentally ill can prevent the unwanted behaviours even from emerging completely, he says.
Working as an architect and consultant, Golembiewski designs mental health facilities, hospitals and care facilities including those for day-care and dementia care and specialised domestic environments. At the same time, he is developing design languages — specific ways to design — to treat a variety of mental disorders, such as depression, anxiety, bipolar disorder, post-traumatic stress trauma, schizophrenia, autism, and Alzheimer’s.
Jan Golembiewski, you’ve been doing research on the impacts of the environment to the human brain for years. What has been the most surprising discovery to you?
The most surprising discovery was that I actually, genuinely discovered something. When I was doing my initial PhD research, I knew what other people had discovered, and I would have been very happy to interpret that to architecture. That was what I was in the process of doing.
But in my research, I came across a dataset by [neuroscientist] Georg Northoff. He had two cohorts in his study: the first with people with chronic schizophrenia or severe bipolar disorder, and the second a matched ‘normal’ control cohort. He showed the groups images while they had their frontal lobes scanned in an fMRI.
Until that point it had been thought that people with extremely regressed symptoms were really locked up in their bodies, and it was believed that they weren’t actually receiving much information from the outside world because they are so unreactive. It was thought that they didn’t perceive properly and that’s why they weren’t reacting. What Northoff found was that on a neurological level, those with regressed symptoms were actually highly reactive. They just, for some reason, didn’t act to those stimuli.
I took the same dataset, and what I found was that when it came to negative stimulus, the psychiatric cohort was actually about 75 times more reactive than the healthy one, which is a huge difference. It was almost like the negative stimulus went straight in, turned into reactions, and came out as symptoms. With positive stimuli, again, the psychiatric cohort was over-inhibited. They reacted less to the positive stimuli than the healthy ones.
When the healthy cohort perceived something bad or disturbing, they were just able to dismiss it. They didn’t act on the negative stimulus. With positive stimulus, on the other hand, healthy people are quite reactive — not extreme, but quite reactive. They almost absolutely inhibit the negative stimuli and under-inhibit the happy stimuli — and that pattern is what defines ‘normal’. People with mental illness are actually inhibiting both the positive and negative stimuli approximately equally.
What I discovered is possibly what a psychosis is, at least on the level of what causes the symptoms. But, I do have a strong theory of what causes the patterns as well.
What does this mean to an architect or a designer?
The finding really throws the cause of the illness back to the environment. Mentally ill people are overreacting to certain things and under-reacting to others, but if the environment is positive, they hardly have any symptoms whatsoever.
Dr. John Zeisel’s work is the perfect example. In the decades that he has been dealing with Alzheimer’s in his work on geriatric psychiatric illness, he has found that if you give people a choice of positive activities to do, they will never demonstrate any symptoms.
Much of your work focuses on researching and designing mental health facilities. In one of your articles, you gave tips on how to design for paranoia. What struck me especially, was one of your tips: ‘don’t just go for homely, go for high quality.’ What do you mean by ‘high quality’?
The idea of designing for the homely or for the institutional is really important. For generations now, everything’s been institutional. Mental health facilities and hospitals are institutional, and the opposite is homely. But if we just design for the homely, we refuse to acknowledge that most people who develop mental illnesses do so at home in the first place. For this reason (and others), homely is clearly not the whole answer. It’s better than institutional, but it’s not sufficient.
We can do a couple of things here: one thing is that we can design for higher quality. If we are designing an institution, we can’t design for everybody’s specific tastes, but we can design in such a way that the quality speaks for itself.
You can go into any really good hotel in the world, any five-star hotel. There will be some that are just kitsch, others that are totally classy, some that are a bit run-down, and each one will have their own energy and vibe — one decadent and beautiful, one that’s chic, and another one with some kind of a Donald-Trumpish vibe — but the quality is there. They say ‘we are here for you.’ Choices matter, and quality matters.
If you are choosing to design an institution in a homely way, you are taking one step away from institutional building and aesthetics. But what about taking two steps? What about taking a step better than a home?
For example, I just designed a childcare facility that had a problem with children not wanting to sleep during the day. Instead of the usual napping mattresses on the floor, I designed a wall between two classrooms. It looks like Swiss cheese, and it’s 1.3 metres thick. The round holes have mattresses at the bottom, and they have little curtains, and little MP3 players so that the kids can choose whether they want to listen a bit of music or to hear a story, and they have adjusted lighting. Kids will love it. You would never get that in a home, that’s how we can make an institution better than home.
In the same article, you write that urban environments are more harmful to the human psyche than nature. In which ways?
When the environment is made for humans, it tells us what to do. We get a constant flood of messages, and many of those are really negative. They tell us to buy things that we can’t afford. They tell us we need things we don’t need. They create all kinds of unfulfillable desires in us and they do so deliberately because they sell products. If you can’t or don’t want to engage with these messages, you are on the outside, and it can be painful. The human environment is callous. It’s mean and nasty.
For the nicest aspects of human environments, you have to go to somebody’s home, because that’s where the designed environment is curated for their own comfort and to be shared with you.
Why the man-made environment is so much more dangerous than the natural environment is really simple. I think that the main advantage of the natural environment is that it’s really hard to ascribe negative intentions to it. If a tree is growing a certain way, it’s not telling you to buy something. It’s not telling you that you should have a bigger penis or a faster car. Right? It’s a tree, it’s innocent. It has a life of its own. If it tells you anything, maybe it’s an invitation to come and climb, or to offer you a gift of its fruit.
How would you describe a psychotoxic environment?
A psycho-toxic environment is one where the environment gets in the way of you finding yourself. That’s certainly a very good definition for houses. My model with interiors, with homes, is that they have to look good and feel amazing — even when they are messy. If you’re happy to show your bedroom to your friends at a dinner party and there are clothes on the floor, and it still looks great, then you have really designed a very special space.
If you have to vacuum the floor before you can even do your own yoga practice, then you have created a psychotoxic space. Forget it, start again. What you have created isn’t a space where you can do yoga and find internal space inside your heart. You have created a space where you can’t find that because no matter what, you can never be comfortable.
And similarly, I guess, it’s the same in a city. A psychotoxic city is one where you can’t find the affordances outside of your own door, when there is nothing inspiring outside the door. You know, if I have to go somewhere else, probably through some horrible streets and experiences, it’s a city that hasn’t got enough to offer. So you can scale these ideas up and down.
You have also written that implementing environmental psychology to architecture could have wide implications to designing the society. How would you apply this to designing urban environments?
As I said earlier, start by having good things to do. We perceive by acting on the choices that the environment gives us. The environment continually gives us choices: ‘please sit’, ‘please walk’, ‘please enjoy the weather’, ‘please accept shelter’. It’s like the environment continually speaks to us. And the more human the environment is, the more it will speak to us, because the environment is designed to do that.
When we’re designing, we’re always designing for people to stimulate the various human behaviours. That creates a language, which is actually telling us what to do. We know that on an architectural level, and certainly on an advertising level.
If you want to design a public environment, you have to be very careful what the language of design is saying. You need to give people things to do; objects and things to engage with. These need to be free or very nearly free, and they need to be delightful. The environment should have a lot of affordance.
Secondly, choice is very important. Having choices creates a sense of meaningfulness. On the evolutionary level, choice means evolutionary advantage. You’re royalty when you have choices. So, if we create not just one good thing for people to do, but a choice of good things to do, the choice itself carries a language of luxury and attainment. A language of quality. With choice, the public environment says ‘I’m here to serve you, for your benefit and happiness.’ The moment your designs start speaking to people on that level, symptoms of mental illness disappear.
You know, we could do such delightful things, but our imaginations are so stuck on precedents, exemplars. What other people have done in the past. But actually, if you look behind, what we’ve created until now is mostly just shit. It’s progressively getting better, but there is still so much rubbish. We need better and better and higher and higher quality, because we have to compete against the intensity of messaging of our environments.
The interview is a part of ‘Spatial Health,’ one of the focus areas of Brussels-based design and research office Raven & Wood Agency. ‘Spatial Health’ looks into crossovers of built environments, spatial design and health with a specific focus on emotional well-being.