I wish to thank, Mr. George Hadjichristou Mr. Michal Stephanidis Mrs. Muroulla Stephanidou (psychology). Mrs. Maria Shiali (psychology in therapeutic community In Ag. Skepi) for their help and assistance on collecting the research material of my research and their help on grammar, vocabulary, citing and outcome of the research.
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CONTENTS Abstract Introduction Chapter 1: Therapeutic Community 1.1 The process of the therapeutic community. 1.2 Time and therapeutic communities. 1.3 (i) The fundamental components and basic structure of Therapeutic Communities.
1.3 (ii) The treatment process-from induction to rehabilitation. 1.4 Life in the therapeutic community. 1.4 (i) Activities in the community 1.4 (ii) Case study: The Kethea Exodos Therapeutic Community. Chapter 2: Therapeutic Architecture 2.1 The role of architecture in therapy. 2.2 Kinesthetics and landscaping. 2.3 Light and shadow. Chapter 3: Therapeutic Architecture for drug addicts-case studies 3.1 Groot Klimmendaal Rehabilitation Revalidation Centre-Arnhem Netherlands 3.2 Renewal through Architectural Design of a Holistic Therapy Drug Addiction Centre, Namrata Shrestha (Architect Student). 3.3 Drug Addicts Hotel Conclusion References List
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ABSTRACT ‘All architecture is shelter, all great architecture is the design of space that contains cuddles, 1 exalts, or stimulates the persons in that space.’
Dismiss one of the great building designers of modern times at your peril. The words of American Philip Johnson who undoubtedly revolutionized the conventional view of architecture in the past century, lie at the core of this paper. Buildings have a cause or as Spiro Kostof puts it ‘are a social act’ and therefore when one is considering individuals with drug abuse problems, the design of their temporary social ‘containment’ so to speak, must not look or feel anything like an exclusion. It must emulate a world which embraces them through spaces encouraging gradual community involvement, a therapeutic process that does not resemble a hospital or foundation environment. A rehabilitation inner and outer space that provides them with the means of understanding what went wrong and how to work-through the group- towards building their own strength to surpass physical and psychological obstacles on the road to recovery and active inclusion. Such therapeutic community buildings must not be designed to remind long term absence from life, but a temporary home away from home, a pathway back to individual stability and societal development. And this short term abode must be enriched with approaches to healing that bring about changes from the inside out. One of them is expression through the arts. ‘Art…can feed the soul, motivate an individual to want to recover and in certain circumstances, cause physiological changes in the body’. 2
1
Accessed at http://thinkexist.com/quotations/architecture/
2
Bernie Warren, accessed in ‘Rehabilitation and education village for young drug addicts, Sarah Ng Ka Ling, March 2000, pg 16 3|P a g e
INTRODUCTION “…Buildings, spaces between them…make different lives, influence how we think, feel, behave-how we are’. 3 Many specialists of various fields, including sociologists, therapists and architects have repeatedly argued about how place and the design of its spaces communicate with the human psyche, affect the way in which people react to their lives and how they develop. And this might be said to be rather crucial for any individual who requires long term constant care or needs to recover from a period of physical, social and emotional instability such as the multi-faceted break down and loss of self brought about by drug addiction. It is important to note from the outset that architecture is not a treatment, but can most significantly become part of the healing process through the creation of spaces that foster and provide meaning to those activities utilized to achieve gradual rehabilitation through a therapeutic environment. Light, colour and movement within a residence as well as landscape and location are essential elements of this architectural therapy and the paper will seek to bring their relevance to the fore in the 2nd part of this paper. “..form and space can be insidious shapers of person and community or they can nourish and spur development, both social and individual”. 4 It is a setting which readies for social inclusion and does not bunch up people as a group of patients who simply need to take their medication or stay indoors for a prolonged period of time but as active recipients of change and individuality. Not merely a number behind a ‘health facility’ door. Architectural design can provide the corner stone of this individuality, with spaces built as an interactive process as opposed to ‘holding a disorder within’. As Cynthia Leibrock puts it, even the little things in the design of a building can play their part in the psychology of the healing equation; such as the way windows reflect the sunlight in a therapeutic community residence. “…The power of a healing environment comes from the design details that empower patients to take responsibility for their own health’. 5 Before delving into how building design can interconnect with the healing process and activities in providing healing for individuals with long term recurring drug addiction problems, one must provide a detailed outlook of the approach that can serve this type of architecture-drug addiction rehabilitation approach. And this is the concept, or rather the healing principle of the therapeutic community, a relatively 3
Christopher Day ‘Spirit and Place’ pg 5 Christopher Day ‘Spirit and Place’ pg 111 5 Cynthia Leibrock ‘Design Details for Health’ Preface 4
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recent way of creating the sort of environment that allows addicts reformation through the development of a team spirit in conjunction with ways of restoring their misplaced individuality.
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CHAPTER 1: Therapeutic Community 1.1 The process of the therapeutic community One of the most widely accepted definition of the therapeutic community for drug addicts is the 1993 Ottenberg thesis of an environment in which ‘people live together in an organized and structured way in order to promote change and make possible a drug free life in the outside society…the community forms a miniature society in which residents fulfill distinctive roles…designed to promote a transitional process…’ 6 It must only be a foundation or facility in name. In essence, the therapeutic community should become ‘society away from society’, a shadow of reality for those with the determination or even so, the decisive push by family and relatives to rediscover and re-coordinate that inner creativity self, the social and individual personality lost through drug abuse. As argued, this type of healing process, its residential philosophy aside (and this is where architectural design comes in), does not usually apply to a fixed setting, “but rather to the principles of the care that is offered…a communal approach which is also democratic, collaborative and encourages participation…”. 7 Thomas Main was the British psychoanalyst who coined this term in the 1950s, as the response of psychoanalysis to the failure of psychiatry, incarceration programmes which viewed addicts as mere criminals and stigmatized them as outcasts or even mentally disturbed through abuse, as well as purely medication approaches. Strangely enough though the therapeutic community model developed by Maine and other analysts was based on a world war two experience in Britain, as army psychiatrists, who had to deal with hundreds of traumatized soldiers returning from the front, considered, in their desperation from the failure of the conventional medication or one to one therapy approach, to apply a group method that would allow those who had suffered severe distress to overcome their psychological fears and return to the front as physically and emotionally healthy as possible.
6
Ottenberg, accessed in scientific magazine ‘Psychiatric Nursing’ at http://nursingplanet.com/pn/therapeutic_community.html 7
O’Hara ‘What are Therapeutic Communities’ August 2010, accessed in ‘Funding Caring’ from http://www.fundingcaring.co.uk/what-are-therapeutic-communities.html 6|P a g e
“The psychiatrists at Northfield Hospital in Birmingham decided to focus on the unit as a whole rather than on individual problems; they structured the wards as communities, encouraging mutual support and cooperation in living.” 8 Instead of medication treatment therefore, they provided the necessary tools to the community of patients in dealing with their own problems, making them part of the process with which they could overcome their traumatic experiences. As Crampling notes, this later became known as the ‘living-learning’ method. Maine took this and applied a psychoanalytic approach to it. Some later appropriately dubbed it ‘social psychiatry’. It formed the beginnings of an attempt to consider drug rehabilitation as a psychological awakening through a group environment, in which members (not patients) and experienced professionals interact in a setting promoting trust and individuals are encouraged to become part of a community with the goal of rebuilding their social skills, such as responsibility and integration. This community philosophy essentially places the healing process into the hands of addicts themselves in a controlled and voluntary but not institutionalized environment, finding methods that allow them to rebuild their ability of dealing independently with their own problems. Central throughout have been the Encounter Groups; the move from behavior modification to social learning, from confrontation to motivation…the ‘ self-help’ and ‘here and now’, plus the gradual erosion of insider/outsider divisions, to becoming part of the wider community”. 9 Many of those seeking or being encouraged by their environment to follow the therapeutic community approach have gone through an extended period of social and behavioral dysfunction, the substance problems gradually eroding-in spite of what educational or professional capabilities they might have had-every sense of societal responsibility, creating a situation whereby they need to essentially re-invent themselves, develop integration skills and individual creativity. This is why this form of residential therapeutic community involves “…an internal hierarchy of jobs and progressive responsibilities, and a variety of medical, educational, and vocational services”.10
8
Penelope Crampling ‘Therapeutic Communities’-Accessed from scientific magazine ‘Advances in Psychiatric Treatment’ from http://apt.rcpsych.org/content/7/5/365.full
9
Malcolm Bruce, Consultant Psychiatrist in Addiction, Review of ‘Therapeutic Communities for the Treatment of Drug Users’ by Rawlings and Yates. Accessed in http://pb.rcpsych.org/content/27/1/37.2.full 10
The New England Journal of Medicine ‘Treating Drug Problems’, Gerstein and Lewin, September 1990, accessed from http://www.nejm.org/doi/full/10.1056/NEJM199009203231230 7|P a g e
Architecture fits into this process, as the outer shell providing the necessary support to the inner self-corrective therapy. There are of course no guarantees of success in such cases. However, at least the connection of interior design and community spirit as a means of molding a socially functioning individual forms an alternative that puts the individual first, as opposed to the medication institution like processes that have not managed to make any headway, both in attracting the trust of addicts who make the step to rehabilitation, as well as eradicating existing prejudices and public opinion views. The therapeutic community, as referred to earlier in the paper is not about being locked in, but a home in which the individual with the need for care, becomes part of the method of their gradual return to physical and emotional health, they become involved in the decision-making process, improving their creativity through the group. The basic premise is to become the change within themselves, to sense that even though they live in a treatment community, the environment surrounding them is one in which they feel not part of the problem, but part of the solution on their way to re-learning the social process. “Individual client members are involved in all decisions about their own care and treatment”. 11 As heard in the 10th European Conference on Rehabilitation and Drug Policy, rehabilitation is not about shutting the door of the world in the face of the addicts, but giving them the ability, through sharing their life experiences to reach a glass door on their own, where they can see social inclusion laying in the horizon. “…for the suffering soul, world is healing”. 12 1.2 Time and therapeutic communities There cannot really be any set length of time in such a self-help programme which depends on the effectiveness of staff in building trust and a community spirit as well as the willingness of members and the triggers provided to them both in terms of the architectural surroundings and healing techniques, as a means of a gradual return to social responsibility and inner growth. Drug addiction rehabilitation is an individual process, so each has their own time. In general terms, logic dictates that the longer an addict remains with a drug-free programme based on an interactive process of self-development, the more positive the result will be, particularly so if rehabilitation is completed, with the benchmark of at least partial success being a minimum of three months. This is particularly true of individuals who have a record of more severe and prolonged substance abuse, such as heroin and cocaine (which now forms the majority in most community programmes), a history of violence and incarceration, mental instability stemming from uses, as well as limited educational ability, which means they are less likely to understand or accept their situation. 11
Service Standards for Addiction Therapeutic Communities, Royal British College of Psychiatrists accessed at http://www.drugslibrary.stir.ac.uk/documents/tc.servicestandards.ed1.pdf 12
th
th
th
Menander, taken from the 10 European Conference on Rehabilitation and Drug Policy-10 -14 May 2005 8|P a g e
“The structure of a therapeutic community, with its community meetings, diverse network of relationships, supportive peer group, strong sense of belonging, means that a strong therapeutic attachment can be forged – an attachment that can withstand high levels of aggression and risk.” 13 But the basic complication of such a residential community method whereby a more specialist architectural design is needed, with facilities to accommodate usually 4080 individuals, has been the cost. Financial limitations have meant, in cases, that an ideal period of up to 2 years rehabilitation often had to be sliced in half or at worst, the residential model of community design treatment, abandoned altogether for cheaper alternatives. The drop-out rate or lack of motivation to join can also become a problem and to this end, more recently, those involved in therapeutic communities have conducted extensive research in order to establish why many addicts often lack the determination to carry on with the programme. What has been established is that stronger family connections are, the more likely an individual is to make a positive decision and remain with the programme in the longer-term. What might also influence addicts to become members of a therapeutic community and stay for the duration or at least a long period of time, are improved job opportunities through skills attainment, as well as fear of getting entangled with the law once again. According to many documented responses by addicts themselves even a limited time at a residential drug-free community, can go a long way. “…I left early (but) what happened to me was I felt the power gained from having peers who were all experiencing the same issues with addiction as me… I am taking baby steps in life. But baby steps or not they are still steps”. 14 Ultimately, the level of self-esteem stemming both from the addicts support system as well as his own vocational and educational past, determines to a great extent whether he decides to go ahead and fully join the programme and more so, whether he has the psychological strength to continue with it. It can be said, in addition, that effectiveness, does also depend from the way professionals structure the community programme and whether they can retain trust. 1.3 (i) The fundamental components and basic structure of Therapeutic Communities Therapeutic communities, drug-free residential settings are primarily of a humanistic philosophy in which the member gradually develops social group responsibility and a sense of personal growth through structured activities but also the opportunity of more creative expression such as theatre therapy, art, photography and prose writing that bring out untold emotions and help the resident through this active self13
Penelope Crampling ‘Therapeutic Communities’-Accessed from scientific magazine ‘Advances in Psychiatric Treatment’ from http://apt.rcpsych.org/content/7/5/365.full 14
A drug addict experience, from the ‘wired in to recovery’ blog, July 2009, accessed at http://wiredintorecovery.org/blogs/entry/2687/rehab-and-the-need-for-a-therapeutic-community 9|P a g e
help process, become aware of their problems and finally come to terms with what brought them to that situation. The member is forced to become part of their future, by developing on a daily basis individually and with the group, having a daily routine, starting at seven in the morning, sharing and having a common target, feeling responsible also through the choice of employment that can be provided at the facility. For example many communities make their own furniture. Work is a means of strengthening the sense of community and developing the communication and interpersonal tools needed. “…the therapeutic community movement holds a multidisciplinary view of health which is based on ideas of collective responsibility, citizenship and empowerment”. 15 The therapeutic community is usually at a distance from city centers where drugs are much more accessible, (but not too far from the reminder of daily life-the sports facilities of the Groot Klimmendaal rehabilitation centre in the Netherlands are also used by the general public as a means for residents to feel social proximity) and close to the positive influence of nature. Funding also determines the location of therapeutic communities. The ultimate aim is for these residences to become a microcosm of real life, a placebo of a social situation, whereby conditions proceed pretty similarly to a societal motif-providing solutions to situations that might come up through activities or assigned work, planning a schedule, following necessary rules, having control over your life as well as realizing that the way one conducts themselves must be respectful to the group. Individual and group therapy sessions are conducted daily, lasting more than an hour and offering the opportunity of openly expressing emotions. “Problems and their solutions are discussed in the community before action is taken. The discussion is regarded as a learning opportunity”. 16 Based on the sociological approach of community as method, residents gradually learn, through a hierarchical system, open communication and expressing themselves in the group and through activities, to discard negative emotions and are “taught to use the peer community to learn about themselves, to change lifestyle and identity”. 17 As Alcorn puts it, gradually building or re-building a new life, for which 15
S.Davies ‘Survival and Growth in the Marketplace-Does every district need a TC?’ in Therapeutic Communities Past, Present and Future, edited by Campling and Haigh, accessed in http://books.google.com.cy/books?id=63yWIz9GUC4C&pg=PA210&lpg=PA210&dq=money+and+ther apeutic+communities&source=bl&ots=8RYbhPgRXR&sig=H6UMNlIZuDdzgZqvlYrdeasxwnA&hl=en&sa =X&ei=51A9T_KaJ8j0sga4ucjzBA&redir_esc=y#v=onepage&q=money%20and%20therapeutic%20com munities&f=false 16
Service Standards for Addiction Therapeutic Communities, Royal British College of Psychiatrists accessed at http://www.drugslibrary.stir.ac.uk/documents/tc.servicestandards.ed1.pdf
17
Mary Alcorn, executive director GCDC ‘What is a therapeutic community?’, accessed at http://www.aic.gov.au/events/aic%20upcoming%20events/2006/~/media/conferences/2006drugdiversion/10maryalcorn.pdf 10 | P a g e
they are fully responsible, always having in mind that professional monitoring is daily and reviewing of the community’s progress is conducted at a regular basis to establish whether the residence is achieving its goals of gradually creating new identities that are well on the road to physical and mental rehabilitation and are, through work and activities inside the community, building new positive strategies of dealing with their problems. Strategies that they will be able to put into practice once they are able to face real social situations. Therapeutic communities “…provide a combination of therapeutic involvements between residents and staff and living in a caring and challenging community as the principal mediums to encourage change and personal development”. 18 1.3 (ii) The treatment process-from induction to rehabilitation In this community environment and following the interviews and assessments that are required to establish whether individuals have completed their preparation in joining, it is psychologically inevitable that members need to be gradually introduced to the new setting, an induction process that takes a month and includes the practicalities of living and working with others in the same quarters. The early stage of this first month of what is to be a major process of change for addicts who decide or consider following down this community two year therapy path occurs at the induction and information centers, usually located in easily accessible city areas. These drug-free ‘corridors’, one might say, to the therapeutic community, provide the necessary psychological support structure, an initial approach to addicts who have made a conscious decision, encouraged by relatives or friends, to seek rehabilitation, through an organized community system. Most important at this stage, are also the information groups, made up of people who are yet undecided on whether they are ready and prepared to go through with this social and personal turn to their lives. It is here, from the outset, that the influence of space is crucial for the success of the programme. Such information centres offering day psychological and health care at a physical and mental basis need to constitute friendly open environments, where the addict is able to experience a community spirit and not institution-like architectural outlooks. This is where they get the first education on how they can set off on a programme of reducing their dependence on substances. 1.4 Life in the therapeutic community Before proceeding to briefly describe how life progresses in the community, one must make clear of the voluntary nature of this approach. Whatever the positives 18
Australasian Therapeutic Communities Association ‘Towards Better Practice in Therapeutic Communities’ pg 13, accessed in http://www.atca.com.au/04_resources/Towards%20Better%20Practice%20in%20Therapeutic%20Co mmunities.pdf 11 | P a g e
might be from making the effort, the addict must first become aware of their predicament and the need to overturn a situation that does not allow them to become an active member of society. As non-profit NGO HelpGuide points out, the biggest and toughest step toward recovery is the very first one: deciding to make a change. 19 And beyond that, since addiction gradually takes hold of all aspects of life, “…Treatment success depends on developing a new way of living and addressing the reasons why you turned to drugs in the first place”. 20 Integration of new members to the community is immediate, once it is certain that they are completely detoxified. Their introduction to this group life starts from the living quarters, as they meet the group orientation leader (in other communities he is described more informally as ‘buddy’, or alternatively mentor and host 21), who will be responsible for their daily work routine, forming one of the fundamental parts of their life at the community, with the philosophy of the medication-free approach stipulating that it will imbue a sense of social responsibility. “As such, job assignments or “functions” begin immediately for new residents, usually with basic housekeeping or maintenance chores”. 22 The American National Institute of Drug Abuse notes in its guide that all activities, as well as interpersonal and social interactions within the community are in essence of opportunities to facilitate individual change. It breaks them down into the group and individual therapy sessions which address the personal issues of residents with feedback from all involved , more open community meetings that are considered to be a review of how the situation is progressing, vocational and educational activities and community and clinical management activities which involve the monitoring of residents both physically and psychologically. 23 The therapeutic community is in essence a self-rediscovery journey, the forging of a lost identity that will allow the individual, re-integration, but also a re-learning of one’s societal role, therefore the structured activities of the resident mirror everyday life through a hierarchical system, whereby complying with the rules and necessary behaviors mean rewards and strengthen the sense of belonging and collective 19
HelpGuide.org, accessed at http://www.helpguide.org/mental/drug_abuse_addiction_rehab_treatment.htm 20
Ibid. Service Standards for Addiction Therapeutic Communities, Royal British College of Psychiatrists accessed at http://www.drugslibrary.stir.ac.uk/documents/tc.servicestandards.ed1.pdf 21
22
magazine ‘Psychiatric Nursing’ at http://nursingplanet.com/pn/therapeutic_community.html
23
National Institute of Drug Abuse July 2002, accessed in http://m.drugabuse.gov/publications/research-reports/therapeutic-community/what-daily-life-intherapeutic-community 12 | P a g e
awareness of the members both for the good of the group but also the step towards inner change through involvement. “Community members are encouraged to think and act as if they have progressed as a means of developing a positive attitude”. 24 Following the first month, the resident is intensively introduced to the therapeutic community approach, by being assigned various chores and activities that are aimed at developing collective responsibility. In most such communities, the member also simultaneously begins continuous day time vocational education, a process of professional learning, in addition to group therapy that is aimed at changing their negative outlook to life into positive emotions and reactions to others as well as to their own psychological state. The approach importantly also has a practical nature, as the resident develops skills and can complete an educational or professional course in several trades, that can increase opportunities of employment. This occurs in parallel with a gradual re-introduction to social relationships. In some cases, the resident is encouraged to re-establish torn relationships with their familial environment, relatives or friends. 1.4 (i) Activities in the community These are very much connected with the need for the development of new skills, but also with the principle of therapy through creativity and recreation. Classes might include literacy and English for those with low education levels, theatre and drama, literature and prose writing, photography and art, as well as sports, very much a part of the mind and body health approach. As this is meant to be a structured routine from morning to dusk, these activities are interspersed in the daily schedule between group and individual counseling sessions, other vocational courses, possible employment offered by the community as a means of providing professional skills (carpentry, computer science, culinary skills, mechanical engineering) and the house chores, such as cleaning and assisting in preparing meals, that are part and parcel of the spirit of community giving and belonging through responsibility. Residents are divided into different groups on a daily basis. Educational programmes provide residents a host of different skills and emotions, a chance to express what they’ve finding hard to release, gradually begin to come to grips with all the negative feelings, the anger, the frustration, the confrontation and psychological abyss that they had found themselves in. For example, theatre and drama classes provide them with the stage expression that gives the opportunity to for role playing that is relevant to their situation, both positive roles but also perhaps a chance to exorcise their demons through story-telling. Some psychotherapists believe that the emotional healing offered by the theatre is one of the best ways in 24
Service Standards for Addiction Therapeutic Communities, Royal British College of Psychiatrists accessed at http://www.drugslibrary.stir.ac.uk/documents/tc.servicestandards.ed1.pdf 13 | P a g e
which an addict can bring their inner self to the fore, come forward with parts of themselves that had been stashed away in their addiction. American psychologist Tom Horvath, founder of Practical Recovery, a wide ranging addiction treatment programme believes that for addicts to play out their emotions on stage, is one of the first steps towards actually reliving through expression and in that way growing out of them, throwing them in the melting pot. But it’s better to hear it from the residents themselves through an experience of a drama therapy session. “…Once our problems were piled up in our figural trashcan in the middle of the room, we chose how to dispose of it all. With laughter, we decided on a spinning vortex to suck away our problems tonight, possibly lighting it on fire next time…” 25 The same idea of healing through the creative release of vent up emotion might be said to be true of prose writing, another form of communication, as well as photography or art. They charge the resident in an artistic manner and this could lead to the start of their re-discovery as individuals, through expression of thoughts that were lying dormant and now can be further developed through art selfexploration. The story of 51 year old Ed, an attorney who ended up buying hard drugs from the clients he defended is characteristic of this method. “…One of the first issues we focused the art therapy on was triggers. Ed had no idea what emotions or situations predicated his desire to use. By responding to pictures that reminded him of his own emotions, Ed began to identify his feelings for the first time”. 26 But even cultivating the land can trigger emotions. Certain therapeutic communities have the option of agriculture products and in this manner, residents have the opportunity to actually offer to the community by providing food for the community that in some cases can also be distributed to markets. 1.4 (ii) Case study: The Kethea Exodos Therapeutic Community This therapeutic community, a programme that began in 1989, is housed in a rural area of central Greece, at a distance from the urban centre of Larisa and can provide full time care for 60 live-in members. It is voluntary and medication substitute free, focusing as the philosophy of these communities goes, on the healing of the individual and the belief that he must play a role in his own catharsis, as the problem is both body and mind. And the aim is to achieve this catharsis through group interaction, which will lead to the path of the new self and change. As noted in the web page of the community it is not always easy to maintain such a facility near an 25
Drama therapy in addiction recovery, October 2011, taken from the Reunion blog, accessed at http://www.reunionsandiego.com/blog/drama-therapy-in-addiction-recovery/ 26
Art Therapy and Drug Abuse-A personal perspective, accessed at http://www.ava-charneydanysh.com/drug_abuse.html 14 | P a g e
urban centre as the public still have many misconceptions and prejudices in regard to this form of addiction, which are often difficult to overcome. However, it has managed to establish itself, providing all the stages of induction and treatment for individuals who decide to take the difficult step of rehabilitation. The Kethea units include counseling centers in Larisa and Trikala, a social reintegration centre for those who have successfully completed the programme, as well as a family support centre and an alternative adult school providing secondary education for former users who have joined or completed the programme. As pointed out the school has a transitional character and is aimed at …”cultivating initiative and the critical mind among the students, intended to make an optimal association between school and learning, employment and life”. 27 Kethea publishes the ‘Exit’ magazine with the main purpose of informing the general public of the mostly psychological nature of drug addiction and treatment. It is an awareness publication and the editorial groups are all members or former members of the therapeutic community. And since we are talking about buildings as contributing factors to addiction reformation it is worth referring to the ‘Temple of Remembrance’, a chapel housed inside the premises of the community. But it is not just used as a chapel. It has been transformed, through both modern and traditional elements into a multi-purpose venue, such as a classroom, an auditorium, a place of worship, but also an arts exhibition and therapy hall, which “…shall give the opportunity to its users to come in touch with art, experience aesthetic pleasure and 'learn' every moment of their daily life”. 28
Figure 2: ‘ Temple of Remembrance’ , chapel housed inside the premises of the community
Figure 1: Art Exhibition Space in the Community
27
Therapy Centre for Dependent Individuals-Kethea, accessed at http://www.ketheaexodos.gr/unit5_en.php 28
Kethea Exodos web page, accessed at http://www.kethea-exodos.gr/naos_en.php (pictures of temple included) 15 | P a g e
Chapter 2 Therapeutic Architecture 2.1 The role of architecture in therapy If drug addiction rehabilitation is mostly about bringing positive feelings to the fore and helping to build a new identity for members of therapeutic communities, then architectural design, is perhaps the most decisive of factors in how space is utilized, both in practical terms and landscape wise, to uplift the spirit and provide the necessary environment in which community daily life and activities can become most effective. Christopher Day believes that buildings have the life the architect gives them, a personality that is either positive or negative, and that aura is captured by those who reside in them. “…The more ‘felt’ are buildings, the more connected to rhythms of day…they value the individuals they will house…environment can heal as well as harm…places of spirit…nourish both individual and society”. 29 A host of studies have shown that the surrounding environment, the ‘place’ as a physical sense, is associated with drug addiction risks. Starting from this premise it can be said that building design is more than just a backdrop to health issues, but is more of a forefront. A wide ranging research paper pointing to the need for safer environment interventions, even though its main topic might be drug injection in public, comes to a conclusion highly relevant to the importance of place as both physical and social in nature. “Place is not simply a set of coordinates, but is constructed through finding meaning in the social and built forms we inhabit”. 30 In other words, the building, a city and the way it is designed does not just form slabs of concrete, but is literally a social construction, that can have an influence on those who reside in it. As outlined earlier, this is more true of people, in this case, addicts who are in a process of rehabilitation, a tough community healing programme that seeks to root out their negativity. In such an instance, the energy and individuality their residence might project could be crucial in how they respond to this process. Colour, they way they are able to move within the building, staircases, connections between rooms, surrounding nature can all play a role, as will be analyzed, not just in underpinning the mood of the residents, but also whether they feel welcome in the building, whether it forms a connection to their emotions and physical presence and by extension if it provides a motivation for them to follow the programme. A
29
Christopher Day-Spirit and Place, pg 117
30
Rhodes, Kimber, Small, Fitzgerald, Kerr, Hickman, Holloway, ‘Public injecting and the need for safer environment interventions in the reduction of drug related harm, pg 1387, accessed at http://www.harmreduction.org/downloads/rhodes2006.pdf 16 | P a g e
rehabilitation centre in the Netherlands has left nothing to chance, paying particular attention to natural but also artificial lighting as both aspects of mood and energy. “…Natural daylight deep in the heart of the 30 metres wide building was allowed. The interior was enlivened by interplay of striking but subtle colours and direct and indirect artificial lighting”. 31 The same connections are made about colour, with Day pointing out that preference in this case is highly personal. For the individual in a therapeutic community the slightest detail in a room, be it his personal space or a place of group therapy and activities might affect the way the individual receives the treatment, bringing about as negative physical or psychological reaction. “…How different is the living grey of an overcast sky or a blue wash over brown to the dead grey of a concrete wall.” 32 Clearly, a building balance or imbalance, whether be it colour, the light in a building, design or even the length of a corridor can affect the way in which residents in a therapeutic community react to the energy of the space and can relax and release themselves. The example of a group therapy session in Reading, England, provides quite an amazing example of how architectural space can play with the psychology of the individual, particularly so when this is a member of a therapeutic community, seeking positivity. The Winterburn Community had moved to a new home and as described, although the building had much more pleasant small group rooms, the large therapy group room looked much smaller than they were used to. And this was not the only detail. The community previously lived in an old mental hospital, so were not used to the modern amenities of the new abode. Even transition to new surroundings can have its effects. “…The dependency culture of being in an old asylum was symbolized every lunch time when the food was delivered and plugged in by a porter”. 33 In essence, the daily life within community housing individuals who need to feel as close to a home as possible must be designed having buildings in mind that are both practical but also do away with any institutionalized emotions. According to Leibrock researchers in the field of anthroposophic medicine have maintained that colour can 31
Case study of Rehabilitation Centre Groot Klimmendaal, Arnhem, Netherlands accessed at http://www.worldbuildingsdirectory.com/project.cfm?id=3517 32
Day, pg 112
33
Crampling, Boundaries-Discussion of a Difficult Transition, accessed in http://books.google.com.cy/books?id=63yWIz9GUC4C&pg=PA210&lpg=PA210&dq=money+and+ther apeutic+communities&source=bl&ots=8RYbhPgRXR&sig=H6UMNlIZuDdzgZqvlYrdeasxwnA&hl=en&sa =X&ei=51A9T_KaJ8j0sga4ucjzBA&redir_esc=y#v=onepage&q=money%20and%20therapeutic%20com munities&f=false 17 | P a g e
be a major contributing factor towards patients regaining health. She describes green as a colour which is psychologically perceived as providing safe refuge, while coral, peach and yellow are seen as warmer choices for a dining room and blue is considered relaxing. In her book ‘Design details for health’, in which she associates good health with the positive aura of space, she argues that warm color hues are often associated with extroverted responses and social contact. “…A monochromatic colour scheme throughout the building may be perceived as institutional…It can contribute to sensory deprivation which leads to disorganization of brain function…” 34 2.2 Kinesthetics and landscaping “…Kinesthesia is the exploration of our environment through movement; this can be movement with the eyes or with our body…” 35 The sense of movement in a space, deriving from the combination of the Greek words ‘kinisi’ and ‘aisthisi’ has been said to affect the way the individual reacts to the building, how it marks their behaviour, mood, how it creates and maintains a positive or negative attitude to the particular situation they are facing. Architecture can become a strong determinant in the successful kinesthetics of individuals,, particularly in the case of people with psychological imbalances such as drug addicts, who have joined therapeutic communities seeking to regain the peace of their inner self in order to build or regain their social identity. So the way they are able to physically interact with their surroundings, the kinesthetics of human bodies, can be said to be decisive in how they adapt to their daily routine in a group community. “Laban refers to movements directed towards other objects and bodies. The latter, termed spatial-movements, construct nearly imperceptible forms of social interaction…” 36
Ziada, utilizing the model of the ritual space of Muslim mosques and Soviet assemblies, argues that building spaces for collective activities, (much like therapeutic communities), can, through their design, produce a positive sense of kinesthetics in individuals, who are in situation of ‘conjoined attention and communal practice’. 37 For people in drug reformation this can be said to be highly relevant, as they need to adapt to their new tasks and responsibilities and learn new skills that can change their mobility in a positive manner. So in other words, improving one’s kinesthetic skills in a setting that encourages techniques and 34
Leibrock, Design Details for Health pg 82
35
Schaap Design your own mind, accessed at http://www.designyourownmind.net/
36
Hazem Ziada, Kinesthetic foundations of spatial concepts and configurations, accessed at http://www.spacesyntaxistanbul.itu.edu.tr/papers%5Clongpapers%5C053%20-%20Ziada.pdf 37
Ziada 18 | P a g e
therapies to do so is a highly significant step towards an improved physical presence that also brings about internal changes. In simple terms, building positivity produces body positivity, as well as techniques to further improve this positivity. Besides, movement is a major part of sensory perception. According to Dutch architect Jasper Schaap, who co-wrote the paper ‘Design your own Mind’ in 2009, contemporary architecture must turn the tide of its alienation, through buildings that are not monochromic and mono-visual, spaces that participate and affect human movement and action, designs which encourage multi-sensory perception, bringing to the fore the power of the senses, beyond the visual and the spatial. As the ‘Design your own Mind’ researchers point out, buildings which encourage a highly positive sense of kinesthesia, connect with the individuals that reside in them. The Schaap thesis is that moving through space with the body, automatically makes the architecture experience less static. What Pallasmaa (cited in the paper) calls ‘the eyes of the skin’. If you manage to wake up these eyes, the building immediately becomes a source of positive energy of particular importance to drug addicts who need to develop a new self. “…If we succeed in enticing the senses, people can participate again in their surroundings and regain their identity in the contemporary world…” 38 A 2000 paper on a Rehabilitation and Education village for Drug Addicts uses the same premise in designing an art therapy room. The senses are prodded through a wide space that allows rich daylight, distance between individuals so each one can feel the space of their own creativity, as well as an informal furniture setting, that further encourages a spontaneous reaction, limiting the emotion, the perception of you will, that this is an exercise or an obligatory activity. 39 But landscape can also contribute to a heightened positive kinesthesia in therapeutic communities, with Ling providing the case study of The Good Samaritan Regional Medical Centre in Arizona, whereby the space triggers the senses through an award winning health design. The surrounding garden awakens “…patients’ senses of sight, smell and touch, prompting body movement by inspiring the patient to explore the garden”. 40 Water flowing through the garden as well as proximity of plants to all patients, allows, as pointed out in the Ling paper, the interactive sense of touch.
38
Shaap, ‘Design your own mind’ accessed at http://www.designyourownmind.net/
39
‘Rehabilitation and education village for young drug addicts, Sarah Ng Ka Ling, March 2000, pg 16
40
Ibid pg 19 19 | P a g e
Figures 3,4 : Good Samaritan Regional Medical Center Gardens Figure 3
Figure 4
But the same effect, it is underlined, can be achieved through keeping an open space landscape simple, without elaborate additions, such as the case study provided of the Harrison hospital in Washington, where the architect focused on creating a stony pattern with the least of plants, creating curvy pathways, a process known as abstraction, that awakens the individual to the realization of their problems and smoothly allows them to concentrate on the therapy.
Figures 5,6 : Harrison Hospital pathways Figure 5
Figure 6
Leibrock introduces the concept of the Healing Garden, whereby nature, through landscaping, becomes part of the therapeutic process. Many addict communities might not have the means to create such conditions, but as the paper will argue through two case studies, when it is possible through design it can provide a much needed psychological boost. Leibrock cites studies linking sunlight exposure to wellbeing and details the architectural innovation of American James Burnett, outlining his plan of a bed-accessible garden so that contact with nature can be re-established.
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2.3 Light and shadow Architecture is the masterly, correct and magnificent play of volumes brought together in light ...the history of architecture is the history of the struggle for light.” 41 Light and particularly the life-giving rays of the sun, have been well documented as a major determinant of vitality and well being, more so in therapeutic environments where such positive natural stimulants can go a long way towards developing the desired attitude to individual change. In therapeutic architecture therefore, the way sunlight is utilized is one of the factors in creating a healthy environment and psychological motivation. The way the corridors are lit, the way the windows are placed throughout the building to reflect warmth and how light and shadow appears in the space, can affect the balance or imbalance of rooms, always in conjunction with colour, shape, interior design and landscape features. Once again it’s all about the way the senses perceive the surrounding environment, the degree that space resonates with the individual self. Marilyne Andersen of MIT is amongst a group of young architects and researchers who have become increasingly aware of the importance of incorporating sunlight in building design. They have realized that… “…Light is not only an amount of energy," Andersen said. Â "It also provides us with the means to reveal spaces and volumes and interact with our environment." 42 For Day, sunlight is a great part of the spirit of place and directly associated with physical and psychological health. It’s all about energy and mood and how it positively connects people with their environment, particularly so when it comes to a long and arduous process of self-healing, such as in addict therapeutic communities. Daylight is also closely associated with kinesthesis and as Day argues, natural light through what he calls interactive directions, constantly changes the colours and shadow dynamic, stimulating the eye, which is essentially for health, ‘…as NASA sensory-deprivation research has demonstrated’. 43 Leibrock offers a host of ideas on how public areas in treatment centres can become more sensory-positive, for example waiting areas, as she points out, where patients and their families will feel more comfortable when provided access to nature and natural light. This can be achieved with the waiting area (or for example group therapy areas in the case of therapeutic communities), being designed in an atrium or adjacent to a courtyard. What is clear to Leibrock is that natural light deinstitutionalizes and humanizes the space, making residents feel they are not
41
” Le Corbusier, 1989, accessed at vol.3 issue 3 of scientific journal Implications from http://www.informedesign.org/_news/mar_v03-p.pdf 42
MIT NEWS Nov. 2006 accessed at http://web.mit.edu/newsoffice/2006/building-tech-1108.html
43
Day, Spirit and Place pg 201 21 | P a g e
enclosed, but receiving therapy in a home-like environment.44 More so in terms of therapy “…sufficient lighting is particularly important in areas where concentration is required, decisions are made or danger is present.”
44
Leibrock Design Details for Health 134-136 22 | P a g e
Chapter 3-Therapeutic Architecture for drug addicts-case studies 3.1 Groot Klimmendaal Rehabilitation Revalidation Centre-Arnhem Netherlands This is the magnificence of ‘therapeutic’ glass where the sunlight is ever-present, bringing residents as close to nature as they might ever hope to be. The overarching characteristic of this two-storey glass rehabilitation centre is direct contact with nature, a landscaping decision that places this building in an idyllic forest environment, but not at a great distance from the city of Arnhem, as the sports facilities of the centre are also used by the community, as a means of encouraging addicts to feel a sense of belonging. “Despite its size, the brown-golden anodized aluminum facade allows the nearly 14.000sqm building to blend in with its natural surroundings”. 45
Figure 7: Groot Klimmendaal Rehabilitation Center at Night
Figure 8: Groot Klimmendaal Rehabilitation Center in the Day
Improving positive kinesthesis is clearly the concept guiding the continuity between exterior and interior, through an innovative height glazing along the central area of the community that connects the internal aspects of the building in a subtle but importantly practical design, which ensures that residents don’t feel enclosed, cut off. The brightly lit façade of the restaurant establishes warm emotions during day meals, with the hall windows virtually touching the surrounding forest in a welcoming environment. “…A strong visual and tangible presence everywhere because of the surrounding nature. The user was allowed to revalidate whilst walking.” 46
45
Groot Climmendaal accessed at http://www.worldbuildingsdirectory.com/project.cfm?id=3517
46
Groot Klimmendaal Rehabilitation Centre accessed at http://www.worldbuildingsdirectory.com/project.cfm?id=3517 23 | P a g e
Figure 9
Figure 10
Figures 9, 10 : Connection between the interior and exterior.
All recreation, fitness and other common use spaces such as the gym, swimming pool, restaurant and theatre are located in close proximity at entrance level. The facilities are also used by residents’ families’ as well as members of the local community. The philosophy behind facilities being used by locals is that the patient, who is placed at the centre of the community gradually, begins to feel re-integrated. The concept behind the design is first and foremost, care and therapy not through detachment and negative seclusion, but designing the building and its spaces to become part of the surroundings and the community. A centre designed to encourage the self-awareness of the residents about their problems and enhance their degree of responsibility in overcoming their problems through their own personal involvement, but also interaction with the group. The open environment of the interior design is set to promote self-confidence, with great emphasis also placed on recreational activities and therapy through arts expression. Architect Koen van Velsen made sure no part of the building is detached by creating a direct route between the different floors, as well as alternative routes to reach different areas. This brings about both a positive sense of physical movement, as well as a community spirit. The interplay between light and shadows is also evident, in combination to other psychologically boosting effects, such as colour and shapes. “…Natural daylight deep in the heart of the 30 meters wide building was allowed. The interior was enlivened by striking but subtle colors and direct and indirect artificial lighting.” 47 In practical terms, the design of mechanical and electrical installations was energy saving, particularly through thermal storage. Designed to be easily maintained for a long period of time, the rehabilitation revalidation centre forms a sustainable multiuse, closely-knit building exuding stimulating therapeutic components. A building arranged not just for use exclusively by residents but also the community, forging a feeling of social belonging for everyone. Complex in its web of connected floors, 47
Groot Klimmendaal accessed at http://www.worldbuildingsdirectory.com/project.cfm?id=3517 24 | P a g e
rooms and public spaces, but also simple in its desire to unite and encourage residents to use and benefit from the whole area, making it practical and accessible, it establishes continuity and a diversity of use, utilizing nature, light, colour and kinesthetics. This was the winner of the 2011 Architecture Festival in the field of health. “…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”. 48
Figure 11
Figure 12
Figures 11,12, 13: Show the interplay between light and shadows, the use the colors, the shapes and the connection of the floors-levels. Figure 13
3.2: Renewal through Architectural Design of a Holistic Therapy Drug Addiction Centre, Namrata Shrestha (Architect Student) In this case study therapeutic architecture is adapted for the implementation of holistic therapies that apply both contemporary and ancient spiritual methods in treating the addict, body and mind. The design, with great emphasis on a landscaping of ‘healing gardens’ and spacious group therapy areas at the heart of the centre, aims at focusing on the personality and life course of the addict, creating a
Groot Klimmendaal Rehabilitation Centre accessed at http://www.worldbuildingsdirectory.com/project.cfm?id=3517 48
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harmonious setting, but also maintaining contact with the outside world, once again, preventing a feeling of institutionalized enclosure.
Figure 14
Figure 15
Figures 14, 15: Holistic Therapy Drug Addiction Centre
Nature is utilized extensively to this effect, with windows reflecting substantial natural light, subtle artificial lighting and large corridors.
Figure 16
Figure 17
Figures 16, 17: Interior Spaces –How the natural light reflects into the space
3.3 Drug Addicts Hotel This building is currently under construction in Amsterdam by architects Kempe and Thill,(Dutch Architects of the year 2011) renowned and receiving numerous awards in Europe for their contemporary new age but practical designs. Once again, the idea here is to do away with any form of design resembling an institutional character, focusing on a community sense of belonging. The residents’ rooms are small yet imbuing the emotion of privacy and hospitality, with a spacious well lit central area used for group therapy of up to 50 people. Dubbed ‘collective living room’, it boasts a window roof for even greater daylight effect with a direct view of the park, establishing visual proximity to nature. The architect had the possibility of creating an open ‘healing space’, a courtyard on top of the building, where the individual stimulates the senses.
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Figure 18: Drug Addicts Hotel
Figure 19: Courtyard on the top of the Building
The concept of a hotel for addicts attempts to implement the philosophy that the addict is a guest, a person being given time in a group environment to rediscover themselves physically and psychologically, passing through as in a hotel setting. 49 Most of the Kempe-Thill projects have a socially interactive inclination, with the importance of light, spacious surroundings, practical connectivity and energy-saving, their defining characteristics. Just consider the sun drenched multi-glass design of a research laboratory and education building at the university campus in Leuven Belgium, that will become one of the most energy sustainable ever constructed in the country. It will form an ideal space for an educational setting, similarly to the need for the re-education of drug addicts. 50
Figure 20: Connection of interior and exterior space
Figure 21: Group Environmental space
49
Drug Addicts Hotel by Kempe and Thills, accessed at http://www10.aeccafe.com/blogs/archshowcase/2011/09/10/drug-addicts-hotel-in-amsterdam-the-netherlands-by-atelier-kempe-tthill/ 50
Picture of Leuven building at http://www.atelierkempethill.com/0106.html 27 | P a g e
Conclusion “I call architecture frozen music”. 51 Not the words of an architect in most definitely not a philosophy paper. In spite of this, Goethe does capture the elements of an inspired building much like those of a musical piece-rhythm, movement, colour and most significantly stimulating the senses. A building must be a tribute to harmonious movement and motivation in a surrounding space. The recent departure of architects from conventional principles of design in the field of health care has been spectacular. Though it has gradually been building, (pun intended) the past decade has been a turning point. Professionals have realized that multi-dimensional practicality but wrapped in simple details is the way forward, with light, colour, kinesthetics, connection of spaces and nature at close proximity (wherever possible) forming the ingredients. Therapeutic architecture has taken a strong anthropocentric turn. When it comes to drug addiction rehabilitation centres, the focus is now firmly towards constructing or transforming existing buildings that are de-institutionalized. Where addicts gradually gain the feeling of awareness, self-confidence and don’t feel they are closed in by a rejecting finger pointing society, but merely passing through the therapeutic community on their way to recovery, re-integration into the group and re-invention of the self. Through group counseling, community work, responsibility, recreational therapy, group exposure, interaction. But in buildings that nudge the senses into self-healing, not push them back oblivion. Day talks of process-based design. It has to be architecture that brings about a continuous process of change, even if the start is just a window reflecting sunlight in the right place. “If architecture isn’t about spirit functionalism what is it about? Process-based design is carried by forces already at work…Ultimately we are co-shapers of the world”. 52 Work with what you have. The needs of the individual sufferer-and don’t use complex constructs-but the materials nature and simplicity of space can provide as the ingredients of a healing design. Truth, beauty, good. That was Plato’s philosophy. And as Structure magazine puts it. ‘Architects are from Plato’.53
51
Johanne Von Goethe, accessed at http://www.quotes.net/quotations/greek%20architecture
52
Day Spirit of Place, pg 240-241
53
Structure magazine, US National Council of Structural Engineers, accessed at http://www.structuremag.org/article.aspx?articleID=337 28 | P a g e
References List •
Accessed at http://thinkexist.com/quotations/architecture/
•
Bernie Warren, accessed in ‘Rehabilitation and education village for young drug addicts’, Sarah Ng Ka Ling, March 2000
•
Day, Christopher. Spirit and Place: Healing Our Environment. London: Architecture Press, 2002.
•
Leibrock A. Cynthia. ‘Design Details for Health’: Making the most of Interior Design’s Healing Potential (Wiley Series in Healthcare and Senior Living Design). Canada, 2000.
•
Ottenberg, accessed in scientific magazine ‘Psychiatric Nursing’ at http://nursingplanet.com/pn/therapeutic_community.html.
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Menander, taken from the 10th European Conference on Rehabilitation and Drug Policy-10th-14th May 2005.
•
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Campling and Haigh, accessed in http://books.google.com.cy/books?id=63yWIz9GUC4C&pg=PA210&lpg=PA21 0&dq=money+and+therapeutic+communities&source=bl&ots=8RYbhPgRXR& sig=H6UMNlIZuDdzgZqvlYrdeasxwnA&hl=en&sa=X&ei=51A9T_KaJ8j0sga4ucjz BA&redir_esc=y#v=onepage&q=money%20and%20therapeutic%20communit ies&f=false. •
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•
Australasian Therapeutic Communities Association ‘Towards Better Practice in Therapeutic Communities’ pg 13, accessed in http://www.atca.com.au/04_resources/Towards%20Better%20Practice%20in %20Therapeutic%20Communities.pdf.
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Kethea Exodos web page, accessed at http://www.ketheaexodos.gr/naos_en.php.
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•
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•
Case study of Rehabilitation Centre Groot Klimmendaal, Arnhem, Netherlands accessed at http://www.worldbuildingsdirectory.com/project.cfm?id=3517.
•
Crampling, Boundaries-Discussion of a Difficult Transition, accessed in http://books.google.com.cy/books?id=63yWIz9GUC4C&pg=PA210&lpg=PA21 0&dq=money+and+therapeutic+communities&source=bl&ots=8RYbhPgRXR& sig=H6UMNlIZuDdzgZqvlYrdeasxwnA&hl=en&sa=X&ei=51A9T_KaJ8j0sga4ucjz BA&redir_esc=y#v=onepage&q=money%20and%20therapeutic%20communit ies&f=false.
•
Schaap Design your own mind, accessed at http://www.designyourownmind.net/.
•
Hazem Ziada, Kinesthetic foundations of spatial concepts and configurations, accessed at http://www.spacesyntaxistanbul.itu.edu.tr/papers%5Clongpapers%5C053%2 0-%20Ziada.pdf.
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” Le Corbusier, 1989, accessed at vol.3 issue 3 of scientific journal Implications from http://www.informedesign.org/_news/mar_v03-p.pdf.
•
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•
Drug Addicts Hotel by Kempe and Thills, accessed at http://www10.aeccafe.com/blogs/arch-showcase/2011/09/10/drug-addictshotel-in-amsterdam-the-netherlands-by-atelier-kempe-tthill/.
•
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•
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