Therapeutic Architecture: An Evolving Paradigm of Understanding and Designing Healthcare Environments and Environments for Vulnerable People

The discussion on healthcare environments in the last 20 years shifts between what is known as evidence-based design and salutogenic environments. These concepts have even been used interchangeably and both come from the broader health sciences field. The former derives from evidence-based medicine concepts and the latter from the theory of salutogenesis from medical sociology, both outside the built environment (BE) discipline and therefore unable to capture the intricacies of space and place. So, once those have been introduced to the built environment the concept has changed from the original theories and they sometimes end up being buzzwords.
Thus, we propose therapeutic architecture as a paradigm that stems from both health and the BE. Under that paradigm, we argue that both tangible/physiological/objective and intangible/perceptual/subjective should be accounted for. For the tangible, we investigate physiological conditions because of illness or disease and how the BE needs to accommodate those, for instance through infection control and thermal comfort. For the intangible, which is not clearly defined in the literature so far, we need to consider aspects of social, hedonic, or aesthetic value. The therapeutic paradigm we offer caters not only to pathological and salutogenic but also to the inspirational, beautiful and artistic potential of the built environment. Those could be opportunities provided by the built environment.
To explore how this concept translates in practice and can be implemented in policy, we will test our theory on three landmark case studies, defining the discussion of the era they were introduced chosen deliberately for their differences: Maggie’s centers, the Evelina hospital and Chinese Covid-19 hospital placed on a matrix that explores different tangible and intangible qualities that these places offer or don’t offer.