Architectural Determinism & the Placebo Effect

Summarised from Jencks, Charles. 'Maggie Centres and the Architectural Placebo." In The Architecture of Hospitals, edited by Cor Wagenaar, 406-412. Rotterdam, The Netherlands: NAi Publishers, 2006.

In this chapter, Charles Jencks describes the beginning of the story around the Maggie Centers - the cancer care centres in Britain initiated by his late wife, Maggie. Before this, he'd had a healthy skepticism about architectural determinism (environment can change behaviour).
During a debate on the BBC with a doctor about the role of architecture, much to everyone's surprise he took the role typically claimed by doctors - "architecture matters for cultural reasons, not because it affected patients that much" - while the doctor took his line - "architecture really does matter for health". When asked why, the doctor stated that if the architecture was really bad, they wouldn't even show up for work.

Another key which unlocked his thoughts about architectural determinism was the concept of a placebo - in it's simplest sense, a placebo is a fake cure that works because of people's belief in it. I was pretty interested in this given my previous life as a medical writer and researcher - over 10 years of my life was taken up analysing and writing up medical research using placebo study designs...

The placebo effect is very well documented in the area of pain relief, for example. Looking up any therapeutic medical research paper on a study using a double-blind placebo study design will give examples of the strength of this effect - a placebo is used in these cases to find the percentage patients showing this placebo effect and compare with effects found in those given the actual therapy (the difference above this being the significant effect). My background gave me this knowledge already, but what I didn't realise was that there is more to the placebo effect than I'd initially learnt:

1. The "Style Effect" - brand name placebo pills relieve pain better than generic placebos, and blue coloured ones work better as sedatives than red placebos. Style and brand obviously matter...
2. The "Cultural Effect" - the placebo effect is highly variable across cultures. For example, the healing rate seen in Germans with ulcers taking a placebo is twice as high as rates seen in patients taking placebos in the rest of the world (and almost 3 times that of patients from the Netherlands or Denmark). It seems to be the individual's varying cultural influence, not just their psychology, that matters.
3. The "Doctor Effect" (or "Caregiver Effect" ) - the more convinced a doctor is that a drug or placebo will work, the more likely it is that it will. Their conviction and enthusiasm has an effect on the patient.

These 3 effects work only because they affect personal belief.

Obviously some medical conditions will respond more than others - pain relief more so than, for example, cancer. However, with cancer other psychosomatic and physical aspects play a role. Lowering stress is well documented to strengthen the immune system in certain circumstances (find ref).

Thus, Jencks argues that the Maggie Centers and their architecture do make a difference in the quality of life and survival rates by reducing stressors in the patients life and providing more support and access to effective treatment. He goes on to say that the additonal 3 placebo effects outlined above come into play here - famous architects are employed to design the buildings because they inspire the caregivers and the patients - but ultimately, the ethos, the team spirit created between the patients and caregivers - that has to be supported by the architecture - is more important. His concluding statement in this respect is:

"Good architecture can make a difference when it underscores the style and approach of an institution. Put as a theory, I would say that when the style and content of an institution are mutually supporting, they can produce the Architectural Placebo."

The main book referred to by Charles Jencks about the placebo effects described above was Daniel Moerman, Meaning, Medicine and the 'Placebo Effect', Cambridge, 2002 (others included Dylan Evans, Placebo, the Belief Effect, HarperCollins, London, 2003;  David Peters, Ed. Understanding the Placebo Effect in Complementary Medicine, Churchill Livingstone, 2001).

The Maggie Center service has 4 main goals, which the architecture & art support:

1. to lower stress through teaching various methods of coping and relaxation
2. to provide psychological support to deal with the loss of control that cancer brings
3. to help patients find the information they need and understand all the potential therapies on offer
4. to operate in a peaceful and striking environment (in which art and gardens play an important role) which supports the activity of the patients and caregivers and other staff

The Maggie Centers are a hybrid of 4 building types

- a house that is not a home (warm, friendly, familiar, domestic)

- a museum that is not a museum (art works, gardens, unexpectedly expressive architecture, providing a meditative and creative place)

- a church that is not a church (a place with the appropriate atmosphere to ask questions about the meaning of their life)

- a hospital that is not a hospital (therapies, counselling)