The Road to Wellness: A Journey via Design Psychology

The road to wellness can be a winding one. I should know. Five years ago I was diagnosed with early stage breast cancer. Faced with a good prognosis, I began my treatment journey. En route, I discovered a whole new path to using Design Psychology as part of the therapeutic process.

It all began when I embarked on the re-design of my bedroom as a means of envisioning a healthy and satisfying future. Warned that radiation treatment often produced fatigue and radiation burn, I purchased "cucumber cool" cotton sheets and luxury bedding that not only would be cozy and make me feel cared for, but help me mentally imagine being cooled down. Each time I arrived back home after treatment, a shimmering bed throw and wall colors in ocean blue and light green aided my "cool" visualization.(1)

Overall, however, such design elements were part of a larger process by which I surrounded myself with colors, fabrics, furniture, window treatments, floor coverings and special objects—all of which connected to my long time desire to learn to sail.

My new curtains, for example, were hung from subtle porthole-like openings. Three carefully chosen artworks of water scenes were strategically hung on my wall. Beige Berber carpet provided an imagined sandy beach underfoot.

My bedroom project, finished on my last day of treatment, was beautiful and meaningful for me. A week later—given the all clear and an extremely low chance of recurrence—I was off to Florida learning to sail. (2)

The Robe to Wellness

My bedroom "extreme makeover" proved great for me, but what about such healing design for others? Luckily, patient-centered hospitals also are re-envisioning their spaces as part of a new trend sweeping the country. For example, Capital Health Medical Center's new Hopewell, N.J. facility includes not only an actual "Oasis Spa" for patients and visitors but exudes a spa-like feeling throughout. A waterfall entrance wall, space dividers made of glass-enclosed leaves, soothing colors and user-friendly patient room furniture designed by architect Michael Graves make for an improvement over CH's older facility where I was treated. Since evidence-based research suggests that views of nature aid in healing (3), rooms at that facility and the nearby, soon-to-open University Medical Center of Princeton both will have single patient rooms with views of nature as well as healing gardens accessible to all.

Still, the use of Design Psychology can go a step further to make such patient-centered healthcare settings not only beautiful but personally meaningful. For example, I wore a golden, embroidered Chinese robe to each of my radiation treatments rather than the usual 'blah' gown. Drawing upon the design power of this dramatic garb I'd grabbed from my closet, I imagined myself an empress staring down cancer. The result? Much to my doctor's surprise, I got no radiation burn. I've now developed a designer robe for women undergoing radiation treatment for breast cancer called the Robe to Wellness, an alternative to the traditional, anonymous hospital robe.

I selected the robe's kimono style, luxurious colors and soft fabric to help women feel feminine, personally empowered and renewed. The robe's leaf print wraps women in gentle botanical imagery, allowing them to envision the healing power of nature.

Uniquely, online and in-person social networking also is crucial to the making of the robe. To provide for women's psychological as well as physical well-being, 'well wishes' messages of support posted by people around the world on www.robetowellness.com have been transferred on to labels. Survivors at the YWCA Princeton Breast Cancer Resource Center in Princeton, N.J. will sew such personal greetings into the robe collars. Both this weekly "Robe to Wellness Sewing Circle" and the robes, themselves, are intended to offer personal, 'woman to woman,' emotional support. Capital Health and the University Medical Center at Princeton have purchased the gowns for women undergoing radiation at their new facilities.

The Human Drama

Why is such personalization important when it comes to healthcare environments? Inevitably hospitals (and patients' homes) are the stage settings against which human dramas are played out. No matter how beautiful the set, each patient/protagonist asks questions (often silently) from the same script, "Will I get better?", "How will my condition affect my life?" and/or even "Has my life been worthwhile?" As the patient's psychological drama unfolds, the healthcare backdrop, the patient's "costume," and other supportive props and players can all help patients imagine themselves as heroes on a journey (4) rather than as helpless victims.

The Healing 'Set' - Designers who encourage hospitals to provide patients with views of nature, for instance, often explain a la "biophilia," that there is an instinctive bond between human beings and other living systems. (5) Understood in the context of the unfolding patient drama, access to natural scenes may be helping patients view their lives from a wider perspective. They (unconsciously) may conclude, "my illness is an inherent part of the universe story. My 'hero's struggle' mirrors the process of renewal, equilibrium and harmony inherent in organic systems (6), as with nature that I see out of my window."

The Healing 'Costume' - As healthcare settings transform into natural, nurturing oases, patients may feel increasingly vulnerable dressed in a contrastingly flimsy hospital gown. Clare Cooper Marcus, author of Iona Dreaming: The Healing Power of Place A Memoir, points out that both home and clothing may represent "a basic protector of self. (7) Especially when trying to make sense of 'self' it may be useful for people to "grasp at physical forms or symbols which are close to or meaningful to them." (8) This may be especially true when patients are struggling to maintain individuality in an institutional setting. Clothing can act as a catalyst that helps patients visualize their metamorphosis from sickness to health, as I did when I imagined myself a queen staring down cancer in the robe I wore to my treatments.

The Healing 'Plot'- In his book, Metaphoria: Metaphor and Guided Metaphor for Psychotherapy and Healing, Rubin Battino, M.S., lauds the benefits of a "guided metaphor" approach that "specifically utilizes the client's story of her life as well as her personalized healing metaphor." (9) He points out:

Everybody grows up with healing and curing stories that they have learned and incorporated from family and friends. Some of these stories are legends within the family or the neighborhood. . . These stories control the way that a person goes about helping herself . . . If your family story is that all Smith men die young of a heart attack, or die "with their boots on," or never show pain, or are survivors, or are fighters, or are weaklings when ill, or . . . , guess how they will approach the diagnosis of a life-challenging disease. (10)

Alternatively, Battino suggests helping patients look towards the future by asking such questions as:

How would you change your evolving life's story? What would be different so that you become who you want to be? What will be the form of these changes? What particular healing images do you sense would work for you? What is your new story? (11)

Even if the patient's prognosis is poor, "Nothing prepares us so completely for death as entering those aspects of our lives that remain unlived . . . (12) Patients can write such unfinished scripts by harnessing the power of Design Psychology.

Healing 'Props' - By redesigning my bedroom using design elements that triggered my desire to sail, for example, I was both envisioning a positive future and using visual metaphors—curtains resembling sails, carpeting like sand, bed throws like glistening water to all aided the visualization of my positive future life story.

How can hospitals similarly incorporate special objects that are personal and meaningful for patients into institutional spaces? Walk down any hospital unit for the long term ill and you'll see many patients already using their own props: Photographs, in particular, are often bedside touchstones. Design Psychology research shows, in fact, that photographs are among people's most special objects. (13) Based on such research, hospitals can design in ways to accommodate such visual reminders of life's meaning.

Healing 'Players' - In the end, however, being ill, is not a rehearsal. Our psychological struggle through illness although, perhaps, invisible, is very real. Thus the presence of caring family, friends and practitioners provides us with support and, ideally, hope and meaning. The Robe to Wellness Sewing Circle, for instance, is modeled on the old fashioned sewing bee that sustained women in bygone years. As my grandfather used to say, "The most important pieces of furniture are the people in the room."

Overall, then, for healing places to be truly patient-centered in the fullest sense, the road to wellness can lead patients through wonderful natural settings. The spaces they encounter can be beautiful and functional. Beyond this, however, the road patients travel to health also can be one they blaze for themselves via the psychodrama of their own story told through healing metaphors—design elements in a healing home or hospital—that express, through Design Psychology, their most fulfilled selves.

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• 1) Psychoneuroimmunology research (Grappell, 1991) has shown that people feel cooler in cool-toned rooms and warmer in warm-toned rooms, although actual temperature may be the same.
• 2) For Further discussion see Toby Israel, The Nurture Report, "Oasis by Design Psychology," (Online Volume III, Issue 3, December, 2009).
• 3) A landmark study by Roger Ulrich (1984) found that patients with views of nature used less narcotic and milder analgesics, indicating lower pain experience. Such patients also had shorter hospital stays and a more positive surgical recovery overall than those whose views included no natural elements.
• 4) According to Joan Borysenko, Ph.D. " A person who is a transformational coper is . . . born or develops the capacity to look at the events in their life in perspective and to look for the deeper meaning in things and to say whatever does go on or happens in my life, I can learn something from it. I can be wiser from it. It is that attitude that often correlates with better health." Minding the Body Mending the Mind: Psychoneuroimmunology and Beyond. (Mentor, Ohio: ACSW, Inc., 1994.) Audio tape 1B.
• 5) Wikipedia.
• 6) Based on comments by Kevin Sink, photographer with a master's degree in physiology and cell biology, Healthcare Design 09 Conference, Orlando, Nov. 2, 2009.
• 7) Clare Cooper Marcus, "The House as Symbol of Self." In Proshansky, W. Ittelson and L. Rivlin (eds.), Environmental Psychology: People and their Physical Settings (New York: Holt, Rinehart and Winston, 1976) p. 436.
• 8) Ibid., p. 436.
• 9) Rubin Battino, M.S. Metaphoria:Metaphor and Guided Metaphor for Psychotherapy and Healing (Williston, Vt: Crown House Publishing, 2002.)
• 10) Ibid., section 17.2
• 11) Ibid., section 17.2
• 12) Ibid., See Battino quoting Steven Levine in section 13.5.
• 13) Toby Israel, Some Place Like Home: Using Design Psychology to Create Ideal Places (Chichester: Wiley-Academy Editions, 2010.)

Recommended Further Reading

Battino, Rubin, M.S., Metaphoria: Metaphor and Guided Metaphor for Psychotherapy and Healing. Willistown.,Vt.: Crown House Publishing, 2002.

Cooper Marcus, Clare, Iona Dreaming: The Healing Power of Place A Memoir. Lake Worth, Fl.: Nicolas Hays, Inc., 2010.

Cooper Marcus, Clare and Barnes, Marni, Healing Gardens: Therapeutic Benefits and Design Recommendations. New York: Wiley, 1999.

Israel, Toby, Some Place Like Home: Using Design Psychology to Create Ideal Places. Chichester, Wiley-Academy Editions, 2003.

Sternberg, Esther M., Healing Spaces: The Science of Place and Well-Being. Cambridge and London: The Belknap Press of Harvard University Press, 2009.

Copyright Toby Israel, 2011.