Mental Wellbeing Demands Nature

Our emotional freedom, our spirit, is nurtured and supported by those environmentswhich are themselves alive.

- Christopher Alexander in The Nature of Order (2002)

Through a focus on exposure to nature in medical centres, there is potential to alleviate the overall stress on the mental wellbeing of their inhabitants. As nature has always had its place in the urban environment through potted greenery or garden courtyards, there has always seemed to be a separation between the natural and the urban. While modern architecture in public spaces has developed a recognition of nature's extensively researched benefits and has placed nature as a staple element in spatial design, it is concerning that medical centres – institutes for rehabilitation and recovery – have neglected nature, leaving an atmospheric sterility most would deem unpleasant. Exposure to nature can envelop all of the human senses, a potential distraction to alleviate focus on pain for recovering patients. Administration of medication and pain relief can also be lessened through nature's atmospheric qualities. Not only does nature facilitate stress relief for patients, but also for the staff operating these institutes 24/7. Natural daylight's well-documented benefits on mental wellbeing and resource efficiency have also been neglected by the current medical centre typology. Furthermore, the most common engagement to nature being windows and exposures can be brought to question as there is potential for a more beneficial impact on mental wellbeing. However, exposure to nature does pose a problem in the medical centre typology as nature is spatially demanding and functional spaces are given higher priority or demand. In light of this, symbolic elements of nature and their positive effects on mental wellbeing can be incorporated into medical spaces where exposure to nature cannot be provided for patients. Through the advancement of technology, biomimicry and biodesign have also provided substantial evidence of similar effects to natural exposure and have the ability to be integrated into urban environments such as medical centres. Such well-documented research on nature's benefits poses a question to its strange absence in places of recovery and rehabilitation.

As natural environments can envelop all of the senses, prioritising nature in the spatial design of medical centres may increase the mental wellbeing of patients rehabilitating in an urban enclosure. Concrete skyrises, vast oceans of black asphalt and zipping metallic vehicles are only a few of the key entities that make up our urban environments. Whilst its benefits of efficiency, business and productivity may bring comfort to many who inhabit these environments, it is clear that the majority of society would not want to spend a long amount of time in them; given most of society find themselves travelling on vacation to nature-centric places of the exact opposite quality. This may be due to a sense of unfamiliarity with man-made structures as these urban environments are merely a blip in the evolution timeline of mankind in comparison to the vast natural landscapes we inhabited previously. Pallasmaa in The Eyes of the Skin describes an interesting take on the reason as to why we are uncomfortable spending copious amounts of time in urban environments stating “Focused vision confronts us with the world whereas peripheral vision envelops us in the flesh of the world." (Pallasmaa, 1996) Pallasmaa refers to ‘focused vision' concerning urban environments as man-made buildings and structures tend to draw a single focus from viewers and in turn elicits confrontation. Contrastingly, he refers to ‘peripheral vision' with natural environments as the vast abundance and lack of singular salience elicits a full body experience and engagement that we react positively to. Ulrich clarifies that the positive reaction to nature we have is due to the fact humans have evolved in natural environments for millions of years - "Evolutionary theory more easily accounts for this wide-spread agreement by proposing that millions of years of evolution have left modern humans with a partly genetic predisposition for responding positively to nature" (Ulrich, 2008) Whilst this preconditioned reaction to nature relates heavily to how “certain types of positive responses were adaptive for early humans and increased fitness or chances for survival” (Ulrich, 2008), it is worth arguing nature’s powerful ability to engage all of our senses has continued to gravitate us to its spatial envelopment. In light of our attraction to nature’s engagement of all the senses, Tanizaki’s In Praise of Shadows explores the importance of darkness in Japanese food culture – “What lies within the darkness one cannot distinguish, but the palm senses the gentle movements of the liquid, vapor rises from within forming droplets on the rim, and the fragrance carried upon the vapor brings a delicate anticipation." (Tanazaki, 1977) Much like humans are attracted to positive experiences in nature, the low-lit environments of Japanese food culture draws an attraction to food through the suppression of vision, thus enhancing all the senses. As exposure to nature is indicative of a positive experience, medical centres

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– environments that are heavily associated with stress and discomfort - should incorporate nature in any space inhabited by recovering patients as the unfamiliarity of urban environments exaggerate stress and induce negative mental health. Pallasmaa claims “…one of the reasons why the architectural and urban settings of our time tend to make us feel like outsiders, in comparison with the forceful emotional engagement of natural and historical settings, is their poverty in the field of peripheral vision. Unconscious peripheral perception transforms retinal gestalt into spatial and bodily experiences. Peripheral vision integrates us with space, while focused vision pushes us out of the space, making us mere spectators." (Pallasmaa, 1996) suggesting the importance of peripheral vision – being nature - in spatial design, posing nature as an opportunity to provide positive experiences for patients in rehabilitation.

Exposure to nature can have positive effects on the mental state of patients in pain potentially resulting in less of a need to administer analgesics. The current state of medical centres where patients undergo physical procedures enduring pain has relied heavily on the use of pain relief substances. However, besides painful processes being a key factor in the stress patients feel in medical centres, another major factor lies within the inhabitation of these spaces of procedure “that are noisy, hinder the presence of family and friends, deny privacy, prevent patients from seeing out windows, or force bedridden persons to stare directly at glaring ceiling lights.” (Ulrich 2008, p.89) Consequently, the mental stress of these factors often contributes to symptoms such as elevated blood pressure and heart rate levels. As the culmination of these problems are generally met with the use of analgesic substances to mediate the mental wellbeing of patients, an opportunity appears in questioning the spatial design of these spaces of inhabitation. Nield provides relevant insight into the motives of current Australian hospital design in favour of cost efficiency as “the state governments of Australia realised there was a link between hospital spatial arrangement (configuration departments and rooms) and operating cost” (Nield 2008, p. 227). Furthermore, Nield (2008, p. 228) indicates the state government’s blame in the 1990s on the high cost of hospitals towards “standards and Hospital Planning Notes” (Nield, 2008) of large metropolitan hospitals. However, the cost lied upon the need to "increase their funding to Aboriginal health services" (Nield, 2008) as smaller country towns lacked the proper facilities. In spite of this, regulated spatial decisions such as “sharing spaces, 'swinging' beds between wards (providing more efficient bed utilisation) and the efficient location of critical departments" (Nield, 2008) took the patient’s mental wellbeing out of the equation. While it is evident that hospitals are expensive for state government to operate, Ulrich (2008, p. 90) argues in favour of patient wellbeing being priority in spatial planning for healthcare facilities - "modern humans, as a genetic remnant of evolution, have a capacity for acquiring stress-reducing responses to certain nature settings and content (vegetation, water), but have no such disposition for most built or artifact-dominated environments and materials (concrete, glass, metal, plastic)" (2008).

Figure 1: Comparison of analgesic doses per patient for wall-view and tree-view groups (Ulrich 1984, p. 420)

Ulrich further proved his agenda on the importance of exposure to nature for hospital patients through his study on patients recovering from abdominal surgery. The study looked at two rooms where patients in one room had a bedside view of a brick wall and patients in another room had a bedside view of trees. As Figure 1 details the average doses over 7 days of weak to strong pain relief substances requested by patients, it is evident that the group situated bedside to a view of nature (trees) overall requested fewer doses. While Ulrich’s studies don’t deem the sole exposure of nature to replace analgesic substances for patients suffering stress or pain, it suggests that exposure to nature as a distraction may alleviate stress and pain during recovery. In light of these studies, the current spatial model of hospitals in Australia

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could benefit from a refocus of design from cost efficiency to centralising nature in spaces of recovery. As a result, healthier mental wellbeing for patients and potentially less of a need for analgesic substances when experiencing stress or pain may occur.

Through centralising nature in the spatial design of hospitals, the mental wellbeing of its staff members would increase in benefit for workplace efficiency and a decrease in patient stress. While exposure to nature is beneficial to patient recovery, it is equally important to consider the staff members of these institutes occupying these spaces under the stress of travelling and operating on patients 24/7. “Occupations such as nursing are stressful because they often involve high work demands, low sense of control, stressful events such as death of a patient, noise, fatigue, inadequately designed work and care settings that force nurses to spend much of their time walking up and down halls engaged in wasteful fetching, and a lack of break rooms or respite spaces” (Ulrich et al. 2006) – Although hospital staff are inevitably involved in stressful environments, it is important to have contrasting environments of peacefulness and separation. Ulrich (2008, p. 93) explores the importance of Gate Control Theory – one of the most influential models in medicine and health psychology for explaining pain - and describes the spinal cord as a gate to the transmission of sensory input or pain impulses to the brain. “To the extent a nature view holds the patient’s focus and attention, and diverts their focus away from pain, gate control theory predicts that nature distraction will tend to close the gate and reduce pain” (Ulrich, 2008) – Through a correlation between studies of nature's distracting abilities and the impact of distraction in the Gate Control Theory, it suggests that a natural view can be utilised in alleviating stress and pain. Furthermore, Ulrich (2008, p.94) explored Distraction theory being that humans have "a limited amount of available conscious attention" (McCaul and Malott, 1984) and that the amount of conscious attention directed to pain, the intensity of the pain would correspondingly rise. He suggested nature - being a pleasant and engrossing subject of distraction – would be effective in reducing pain.

In light of this, it is worth exploring Hozak, Gregory and Nelson’s (2016) analysis of Jean Watson’s Theory of Human Caring as it not only revealed “a statistically significant correlation between nursing staff members’ care for self, job satisfaction, and perceived competence in caring for patients” (Nelson, 2014), but also a correlation between the spatial design of hospitals for nurses and efficiency in caring for self and patients. This theory of Human Caring was experimented through their analysis of two hospitals, one situated in an urban setting and another community hospital within Northeastern U.S. (Hozak et al, 2016). Four psychometrically tested surveys – Caring Factor Survey (CFS), Caring for Self (CFS-CS), Caring Factor Survey – Care Provider Version (CFS-CPV) and Healthcare Environment Survey (HES) - were assessed within these two hospitals gathering statistics on a set of architectural elements within hospital institutes – major architectural change, unit size and shape, intersecting hallways, number and distance from bathrooms, room for nourishment, number and distance from supply rooms, rooms for staff solitude, staff gathering rooms and rooms for practice of Watson Caring Factors (Hozak et al, 2016). “In the literature review, primary outcomes such as enhanced communication and reduced patient stress were attributed to lighting, views of nature, and single rooms. This study provides support for extending this view to elements in this study that may enhance the perception of caring” (Hozak et al, 2016) – Evidently, the study suggests nature being beneficial in spatial design for hospitals as it contributes positively to mental wellbeing for staff and in turn for patients.

Natural light in comparison to artificial light has the potential to heal the mental wellbeing of patients within medical centres. “Daylight is consistently identified as an important and preferred feature by most people in the built environment. The simple use of natural rather than artificial light can improve morale, comfort, and health and productivity. This preference reflects the fact that humans are a largely diurnal animal, heavily reliant on sight for securing resources and avoiding hazard and danger.” (Kellert, 2008) As humans have evolved over millions of years, our instinctive response to nature has been developed to be positive whether it is conscious or unconscious. While it may be quite easy to replicate and simulate the illumination of sunlight, our senses can pick up on the other elements of natural light that differentiate it from the artificial. Some of these indicative features of natural light are its specific warmth, its hue and the position of the sun in the sky. Natural light's effectiveness on humans doesn't derive solely from its illumination, but rather a culmination of all its factors. Natural light intake also majorly affects the body’s circadian rhythms – the 24-hour internal clock that runs in the background of your brain to

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determine between sleepiness and alertness. As patterns of light reach the back of the eyes, they are converted into neural signals that synchronise the body’s ‘biological clock’ with the local time on Earth. The hypothalamus portion of your brain controls this rhythm, however, outside factors like lightness and darkness can also affect this. Therefore, as your circadian rhythm is determined by the amount of light being picked up by the eyes, daytime, and nighttime is very important in determining your energy levels. The circadian rhythm within humans determines the way your body functions in numerous ways including sleep-wake cycles, hormone release, eating habits, and digestion and body temperature. A particular hormone that your body’s circadian rhythm determines is melatonin - the hormone that tells your brain that you’re tired. The less light that is taken in by the eyes and communicated to the brain into neural signals, the more melatonin the brain makes resulting in drowsiness. Thus a synchronised circadian rhythm is important to maintain for its energy levels to be high and low at the right times. Unsynchronised circadian rhythms have also been discovered to put people at higher risks for cardiovascular disease, diabetes and other forms of cancer (Figueiro et al, 2016). Furthermore, the substitution of natural light for artificial light in medical centres has been proven to be the cause of certain diseases in patients. Peter Barss and Kathy Comfort conducted a study on newborn infants nursed in a ward in the tropics and found the architectural design of the roof obstructed natural light during the day time. As a result, the breakdown of bilirubin in the infants within the ward was restricted causing an increase in incidences of jaundice. (Barss et al. 1985) In light of Barss and Comfort’s findings, the restrictions of natural light in healthcare centres have the potential to not only inhibit the healing of mental wellbeing for patients but also have the potential to cause harm in situations where natural light is necessary. It can be argued that the instability of natural light can be restrictive in illuminating healthcare facilities where control is necessary. However, developing technologies such as sun finders, heliostats or complex engineered glasses, etc. may deem necessary in allowing natural light to penetrate these spaces as its benefits to the mental wellbeing of patients are important.

While natural light has the potential to heal the mental wellbeing of patients as well as prevent harm to patients, its energy can be utilized to increase resource efficiency. "Sustainability Victoria outlines that lighting typically consumes up to 26 per cent of a commercial building's electrical bill" (Space for Health, 2017) With artificial lighting consuming more than a quarter of hospital electricity bills, it poses the question as to why hospitals aren't heading in a direction to utilize the powerful and free energy provided by the Sun to illuminate their spaces. Natural light possesses ecological and practical value as it is renewable energy with no negative influence on the environment and also a positive impact on psychological health. However, as the unpredictability of natural light in healthcare facilities impacts situations where a controlled level of lighting is necessary - such as surgical operations – artificial light would still be used. In regards to all other spaces where the control of lighting isn't as necessary, the architecture of these spaces can be considered. "The architectural designs, including orientation, building shape, plan, section, windows and the materials of the building surface, all play direct influence to the flow of natural light" (Ming et al, 2011) Through a consideration of these contextual factors during the design of healthcare facilities, the architecture has an opportunity to respond effectively to its environment to utilize natural light at its full potential.

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Figure 2: Fort Belvoir Community Hospital, US, Site plan (Ming et al, 2011)

Figure 3: Fort Belvoir Community Hospital, US, Photo (Wikipedia)

Fort Belvoir’s Community Hospital (Figure 2 and 3) represents a careful

consideration in orientation for hospital architecture. The design of the building was set in such a way that it would respond effectively to the curvature of the sun's path in the sky. As all of the important public spaces, treatment rooms and wards are positioned south of the building; full use of natural light is achieved.

Figure 3: The new expansion for the American University of Beirut Medical Center (Johnson et al, 2017)

The American University of Beirut’s new expansion for their medical center set to be built in 2023 puts into practice a design

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harnessing the movement of the sun to illuminate each level. The building utilizes a central light well (Figure 3) to illuminate and fill its interior space with an abundance of natural daylight. From the top level to the basement, a void is situated in the centre of the floor allowing access of sunlight from the top. Using a heliostat – a mechanical device that turns a mirror plane to keep reflecting sunlight onto a target - to compensate for the sun’s apparent motion in the sky, natural light can penetrate the interior of the space much more effectively than a traditional light well. In turn, the building can maintain a desired amount of sunlight to illuminate its interior as well as be energy efficient. Furthermore, as the building's inhabitants can indicate the source of illumination as being natural light, a sense of exterior space is brought into the interior effectively aiding in circadian rhythm and providing the benefits of nature’s presence.

Through redesigning views of nature to respond with their exterior environment, a genuine engagement between inhabitants and nature would form, resulting in a positive impact on mental wellbeing. “Does this attraction, this seeming instance of “biophilia,” indicate that we are enjoying our control over, i.e., our dominion over and thus our secure distantiation from the “prickle” of nature; or do we imagine that we are truly bonding with or engaging the world outside” (Bloomer, 2008) – Bloomer’s insight on nature views and windows can be applied to the design logic of medical centres, questioning the meaning behind prioritising ‘views’ over ‘engagements’ for patients recovering in these healthcare facilities. More specifically, is our current design of windows in these places of recovery doing more for engaging or separating us from nature? While it may seem purposeful for windows to be as transparent as possible to focus on the outside, it is worth arguing that a disconnect between the inhabitant and the window design itself results in a disconnect between the inhabitant and the outside as these windows simply frame an image of the outside. In particular for medical centres where an abundance of medical wards are to be situated in the same area and of similar functionality for efficiency, their windows to the exterior are mere images to patients. As Betz suggests in regards to representational imagery, medical centre exposures to nature serve more or less as representations of nature rather than genuine envelopments as a result of disregarding the design of the exposure itself (Betz, 2016).

Figure 4: Nature viewed through a clear panelled window (Chen, 2013)

Figure 5: Nature viewed through mullions and small panels of glass (Thorverton Stone)

In light of this, the most common intervention that allows inhabitants to experience nature - being windows – must be taken into consideration to not frame nature as merely an image. Figure 4 (Chen, 2013) depicts the typical view of hospital windows being a simple image of the outside while Figure 5 depicts a mullion window design. “…the intimate threshold between being inside and outside a building was materialized with a wooden or stone grillwork. By touching or being able to imagine touching elements within the space of the threshold, you may heighten your sensual association with the world outside.” (Bloomer, 2008) – As Bloomer describes, the engaging design intent depicted in Figure 6 could be translated into the design of hospital wards giving a sense of engagement for patients within healthcare facilities. By adding elements of the outside view such as wood into the design of the viewing threshold, a sense of touch is formed at the very moment of divide between inside and outside. Furthermore, with windows designed in response to its view of nature such as mullion patterns in the likeness of branches on a tree, another connection is developed between the inhabitant and the outside.

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Figure 6: Tadao Ando’s Church of the Light (Kroll, 2011)

In relation to connecting the interior of space to the natural environment, Tadao Ando’s minimal and powerful architecture expresses an impeccable ability to create beautiful apertures to nature. “His repeated use, in many works, of apertures between his walls and ceilings is not only for the architectural purpose of identifying the independence of the two planes or to beautify the interior walls with patterns of falling light. Their essential purpose is to render the perfectly proportioned spaces fluid through the admission of nature. By measuring time and nature through the movement of shadows, or the sound of rain on the roof lights above, these apertures unite the life of the space itself with the lives of its human occupants." (Pare, 1996) Prolific English photography Richard Pare’s description of Ando’s work describes perfectly the success of Ando’s windows to nature. The simplicity of designing a window in the shape of a cross in Figure 6 may seem too mundane if done by someone else, but Ando’s consideration of the space’s orientation to the Sun and the amount of light that enters the space makes a great precedent in designing views to nature in architecture. Furthermore, such engagement of a space’s inhabitants and nature has the potential in the design of medical centres for the mental wellbeing of its patients.

Symbolic elements of nature and their positive effects on mental wellbeing can be incorporated into medical spaces where exposure to nature can't be provided for patients. Although exposure to tangible natural environments is effective in mediating mental wellbeing and stress relief for patients and staff, hospitals are limited in certain programmatic spaces where a controlled environment is necessary. Consequently, the spatial designs of these spaces lack the opportunity to subject patients to nature. However, it is evident that spatial designs and visuals symbolic of nature – such as digital screens or audio simulating nature scenes - can be implemented into spaces where nature cannot be present. Diette and a group of other researchers conducted a study on patients undergoing painful bronchoscopy; one control group viewing a blank ceiling and another group viewing and listening to a television screen of nature scenes. Using a multivariate ordinal logistic regression model, each participant’s results deduced that the use of video and sound lowered pain and anxiety significantly (Diette et al. 2003). “A study of burn patients suffering acute pain showed that distracting patients during burn dressings with a bedside television screen displaying nature scenes (forest, flowers, waterfalls, ocean, wildlife) accompanied by music lessened both pain and anxiety/stress” (Miller et al. 1992) – A similar study to the patients undergoing bronchoscopy was researched and noted a significant effect representations of nature had on distracting patients suffering burn pains.

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Figure 7: The Northfield Hospital Radiology Suite’s virtual skylight (Sky Factory, 2017)

Northfield hospital’s radiology suite features a virtual skylight depicting a blue sky and trees for patients undergoing MRI scans to focus on. “Designers will often place back-lit photography to simulate a sky view based on the general principle that nature art is conducive to reducing stress. However, representational imagery is symbolic and, while fostering a positive effect on the observer, does not trigger a genuine, physiological response to the environment” (Betz, 2016) Whilst Betz indicates that simple depictions of nature lack the ability to reduce stress and cause a genuine response, Sky Factory’s skylight design employ further design features creating the illusion of nature, mainly to activate brain activity in the cerebellum. “Brain activation of the cerebellum is often associated with aspects of spatial cognition, in particular the experience of extended space, as well as imagined, or real, motion through that space” (Betz, 2016) David Navarrete’s skylight effectively utilizes the ceiling grid (Figure 7) to purposefully obstruct features such as the clouds and trees in the image to create a sense of depth and the idea that the features are beyond the ceiling grid. By having the resolution of the trees and foliage in the image much higher than the clouds above, the image can further create a sense of depth. Furthermore, the blue colour of the sky and its light intensity effectively cues circadian rhythms in the patient subjected to the image. In light of representational forms of nature, Kellert outlines in Biophilic Design (2008) a list of key shapes of forms that are "simulations of the natural world often found on building facades and within interiors" (Kellert, 2008). Some of these include; Trees represented through column supports in architecture, Animal motifs represented through ornament, decoration or art, etc. and Shapes resisting straight lines and right angles represented through architectural forms with more natural infrastructures (Kellert, 2008). The importance of Kellert's list of natural shapes and forms is its potential in being integrated into the spatial design of medical centres. Furthermore, such shapes and forms have the potential to be integrated into restrictive spaces such as "treatment spaces where measures such as pressurized air, HEPA filtration, and sealed windows are needed to protect immunocompromised and other acutely vulnerable patients from infection" (Ulrich, 2008).

Where exposure to natural environments has its spatial limitations, technological development in biomimicry has the potential to provide similar benefits on mental wellbeing. While a lot has been said about the power of nature's influence on the mind, a problem arises in the convenience of natural environments in places of inhabitation. Most would agree that vast forests of trees evoke a substantially powerful presence on humans in comparison to a potted plant in the neutral hallway of your office

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building. However, for nature to truly envelope the mind and produce a positive effect, an abundance of space and specifically curated environments are necessary. Concerning the typical medical centre, nature finds its place in dedicated outdoor courtyard spaces as well as small potted greenery throughout lobby spaces as mere symbols of nature's existence in such unnatural environments. However, as these spaces of rehabilitation and procedure require certain control of atmospheres to maintain the health of patients or allow staff to undertake the rigor in medical research, nature's unpredictability poses as a problem. Exposure to natural environments in certain places within medical centres is difficult in spaces where specific control of lighting, humidity, or temperature, etc. are necessary to facilitate rehabilitation. “…there are certain highly stressful medical settings where it is not feasible to provide visual contact with real nature even through windows, such as an underground shielded room for radiation therapy or the tight confines of an MRI scanner" (Ulrich, 2008) As a result of nature’s inconvenience and unpracticality, medical centres have prioritised technological instruments in order to control these atmospheres, leading to patients in recovery to be subjected to static artificial light. While the static nature of these atmospheres isn't the best environments for patients in rehabilitation to be subject to, technology must be utilized to sustain a sense of control. In light of the rapid progression of technology, there lies the potential in harmonizing the control technology provides and the benefits of nature on the mental wellbeing of patients. "Biomimicry is the act of learning from nature, borrowing designs and strategies that have worked in place for billions of years" (Benyus, 2008) Through biomimicry, medical centres have the potential to emulate certain aspects of the natural environment in restrictive places. As circadian rhythm has been proven to be a crucial internal system to mediate for recovering patients, the static and artificial environment of medical centres is quite counter-productive. In light of this, the Lighting Research Centre (Figueiro et al. 2016) has taken biomimicry to artificial lighting by developing a metric system called “circadian stimulus” (Figueiro, 2016). With this system, the amount of light produced by artificial luminaires can be measured to determine their effects on circadian rhythm, and potentially be used to program lights to mimic natural light. “When specifying lighting for the circadian system, it is important to consider light level, spectrum (color), timing and duration of exposure, and photic history (previous light exposures)” (Figueiro et al. 2016) – Through considering these factors and measuring according to circadian stimulus, lighting fixtures can be tuned on a timed basis to provide the correct CS dosage for patients recovering.

Figure 8: General example of how luminaires can be tuned to provide a healthy amount of CS for inhabitants subject to artificial light (Figueiro et al. 2016)

With Figure 8 referring to Output (amount of illuminance), CS (circadian stimulus), EH (horizontal illuminance on the eye), EV (vertical illuminance on the eye) and colour gradation over time, a program for lighting fixtures mimicking nature can be set up specifically for patients in medical centres undergoing rehabilitation. Furthermore, the incorporation of nature in urban environments doesn't have to be restricted to emulation. "Biodesign harnesses living materials, whether they are cultured tissues or plants, and embodies the dream of organic design: watching objects grow and, after the first impulse, letting nature, the best among engineers and architects, run its course." (Myers, 2012) Biodesign being a progressive concept on architecture has the potential to find its place in urban environments and will most definitely become a staple in design through the progression of technology.

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Figure 9: Harmonia 57 by Triptyque (Kon, 2008)

Triptyque’s Harmonia 57 located in Sao Paulo, Brazil is a clear example of biodesign in architecture. “Rainfall and wastewater are collected, treated, and reused, thereby creating continuous cycles much like in nature… The walls are made of porous concrete, with pore-like openings interspersed throughout for plants to take hold. The water system envelops the whole edifice in a light mist, utilizing internal resources to maintain a healthy exterior, like sweat cooling the skin.” (Bousquet et al., 2014) Harmonia 57 not only embraces nature's processes through emulation but successfully incorporates nature itself into its structure, resulting in inhabitants being able to be enveloped in a natural environment with an urban infrastructure. While biomimicry is still an inferior emulation of the natural environment, it has the potential to incorporate nature's benefits on mental wellbeing into restrictive spaces in urban environments such as medical centres that would otherwise not allow natural exposure. Furthermore, with the progression of technology, biodesign has the potential to harmonize urban and nature to greatly benefit mental wellbeing.

The benefits of exposure to nature and its well-documented evidence may seem obvious and something everyone would agree upon without question. The presence of nature since the dawn of mankind on Earth has ingrained an instinctual attraction to natural environments to a point where we don't even acknowledge it; we simply associate mental positivity to nature. However, the question still stands as to why the spatial typology of medical centre’s – places for recovery and rehabilitation of the mind and body - seems the most devoid and distant from nature. It may be understandable for medical centres that have been operating for decades to lack the incorporation of nature, however, the abundance of information and research that has been accumulated poses no excuse as to why nature shouldn't be the foundation for spatial design in medical centres. Whether nature can envelop all the senses, relieve stress on patients and staff or illuminate space for the better, these benefits are only a fraction of how nature can benefit spatial design. The advancement of technology may seem regressive in creating more natural environments, though on the contrary, it only brings potential in emulating natural environments in restrictive spaces as biomimicry and biodesign continues to develop its plethora of research and benefits on spatial design. While the future of fabrication might become artificial with the advancement of technology, it only poses the question to whether we will use technology to embrace nature even further, or to rid it of existence.

References

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Barss, P., Comfort, K. 1985, "Ward Design and Neonatal Jaundice in the Tropics: Report of an Epidemic." British Medical Journal 291: 400-401

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Bousquet, G., Bueno, C., Sibaud, G., Raffaelli, O. 2014, 'Chapter 1: The Architectural Hybrid - Harmonia 57', in W. Myers (ed.), Bio Design, Thames & Hudson, High Holborn, London, pp. 22-25

Chen, L., 2013 'Windows with a Biodiversity View', The Nature of Cities, viewed 9 June 2019, <https://www.thenatureofcities.com/2013/04/21/windows-with-a-biodiversity-view/>

Diette, G.B., Lechtzin, N., Haponik, E., Devrotes, A., Rubin, H.R. 2003. 'Distraction Therapy with Nature Sights and Sounds Reduces Pain During Flexible Bronchoscopy: A Complementary Approach to Routine Analgesia' Chest 123(3): 941-948

Figueiro, M.G., Gonzales, K., Pedler, D. 2016. 'Designing with Circadian Stimulus' The Lighting Research Center pp.30-34

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