When Fred Foote (1), a military man's son, suffered a burst appendix at sixteen, he was whisked off to Bethesda Naval Hospital for treatment. He spent three weeks on its surgical ward where men, brought back from the Vietnam War and "shot to pieces," lay suffering and dying. Then and there, Foote decided that some day he'd do something to heal the wounds of war.

The day has come. After a career as a Navy neurologist, including stints in Iraq and Afghanistan, Foote's long- nurtured Epidaurus Project on Patient-centered Care and Design is soon to be full-born. What is this project?

The original ‘Epidauros' healthcare complex was built by the ancient Greeks. It relied on a holistic approach where "the cure was cultural, spiritual, topographical and medicinal." (2) Inspired by this approach and remembering his vow, Foote began putting together a project of this same name in 2000. Working groups of medical/architectural gurus and a conference later, four design principles now serve as a template for the "hospital of the future"(3):

I. The building and its landscape promotes the integrity of the clinical encounter
II. The building empowers the patient
III. The relief of suffering is a primary goal
IV. The building actively promotes a lifelong healing interaction

By Sept 15, 2011, three such holistically designed flagship hospitals will be completed, including one in San Antonio, the new Walter Reed National Military Medical Center in Bethesda, and Ft. Belvoir Community Hospital in Virginia. Hallmarks of the hospitals will include a human-scaled "spa" appearance, sleepover beds for families, spaces for spirituality, wellness centers, and many more forward-thinking initiatives.

Of special interest to psychologists is the pioneering work in the treatment of brain injury planned by their National Intrepid Center or Excellence (NICoE). It's intended to be the nation's leader in traumatic brain injury/psychological health diagnosis, treatment, research, and education. Based at Walter Reed, it will include integrative medicine, wellness and family support programs. NICoE has four virtual reality suites expected to be especially effective in the treatment of warriors suffering from post-traumatic stress disorder (PTSD) (4).

NICoE's ‘CAREN,' a very advanced on-site virtual reality machine (one of nine in the world), will help create a whole virtual reality room to assess and treat patients via a type of exposure therapy. Its system can program imagery that re-creates a battle scene or simulates a walk in the countryside. With even floors that tilt and move, will such a room enabling soldiers to re-experience battlefield trauma or (alternatively) surfing bliss, help warriors with PTSD get better? A mission of the project is to find out.

The use of visuals as part of mental health treatment is not new. This project, however, pioneers a whole new frontier by using virtual imagery to enable healing by design.

1) Frederick Foote, CAPT, MC, USN, NNMC
2) Charles Jencks and Edwin Heathcotes, The Architecture of Hope: Maggie's Cancer Care Centres (London: Frances Lincoln, 2010) p. 55.
3) Y. August, F. Foote, S. B. Frampton, K. Hamilton, W. Ruga, S. Verderber, The Epidaurus Project on Patient-Centered Design General Design Principles: Summary (Online archived document, 2006).
4) Foote estimates that 15% of all warriors who served in Iraq and/or Afghanistan have suffered from these injuries.

Copyright Toby Israel, 2011

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