If most contemporary hospital architecture is designed for an industrial model of sick care, what would a truly healing architecture look like? The people who created the Vidar Klinik in Jarna, Sweden, think they know.
The clinic, founded in 1985, doesn't look like a hospital. But then it doesn't perform many of the functions of the typical hospital. There is no surgery suite, no emergency room, no radiography department, no laboratory and no intensive care. Those functions may be necessary to the treatment of illness, but strictly speaking, they don't heal. The body heals, and humans require certain environmental conditions to heal most fully, the Vidar Klinik staff believes.
Where the conventional hospital is big, bustling, technocratic and challenging, this facility is small, intimate, silent and embracing. It celebrates the role of human touch and realigns healthcare to the human scale.
Situated in a meadow within view of a Baltic fjord about 30 kilometers
(20 miles) south of Stockholm, the Vidar Klinik is part of a small community of enterprises, structures and homes devoted to living out the philosophy of Rudolf Steiner.
Steiner, who lived from 1861 to 1925, was an Austrian theoretician, writer and lecturer who founded an international movement called "anthroposophy."
Anthroposophy is best described as a disciplined way of looking at the human being and striving for harmony among the individual, society and the natural world.
Steiner's followers are mostly concentrated in the Germanic countries of Northern and Central Europe. In the U.S., the most salient institutional embodiment of the anthroposophical movement are the Waldorf Schools, which use Steiner's education method to enhance children's artistic responsiveness.
About 15 anthroposophical hospitals exist around the world, but none in the U.S., says Christian Wessling, M.D., president of the Physicians' Association for Anthroposophical Medicine, based in Ann Arbor, Mich. An anthroposophical community in Rockland County, N.Y., has built a long-term-care center in nearby Chestnut Ridge, N.J., he says.
The Vidar Klinik is the only hospital devoted to complementary medicine in Scandinavia. Patients come from all the Nordic countries for its services. The physicians and nurses who practice there have been educated in conventional medicine, with extra training in anthroposophical medicine.
In the building of the Vidar Klinik, Swedish architect Erik Asmussen attempted to create a physical representation of the healing philosophy practiced within.
He has succeeded, judging by the reactions of about two dozen U.S. and European architects and healthcare professionals who toured the facility as part of the Second International Conference on Health and Design in Stockholm in June. The architects found the building profoundly affecting.
Not only does the Vidar Klinik not resemble a conventional hospital, it doesn't especially look like any established building type-certainly not a doctor's office.
The structure is an irregular two-story polygon built around a central courtyard. The roofline meanders up and down, a vertical image of the internal hallways, which avoid straight lines. There is hardly a right angle in the building. The ceiling shapes vary from room to room. Even the patient rooms are shaped irregularly.
"I don't like it on the outside. It looks very heavy to me," said architect Angel Garcia Alvarez, of Madrid, Spain, who was visiting the clinic for the second time. "But I love it on the inside."
The building works by incorporating the senses into the design program at every opportunity.
Color. Steiner developed an elaborate theory of color, which is integrated into the clinic design. Different colors are associated with different physical problems and the visual stimuli necessary to correct them.
Most patient rooms are pink, which is meant to be healthful for the spirit. Certain rooms are blue, the best color for migraine sufferers.
Other rooms are combinations of those two colors. The corridor walls are yellow, and the entryway is floored in pink marble.
Following Steiner's teachings, the paints are not deep, saturated colors, but pale washes across the stucco walls.
Shape. The structural pieces supporting the roof in such rooms as the music studio resemble the limbs of a tree, constantly invoking the irregularities of the natural world.
Light. The pitch of the roof is calculated to allow the maximum sunlight into the courtyard during the long months when the Scandinavian sun barely rises above the horizon. The windows are large and variously shaped, with diagonal crossbars. Every patient room provides a view of nature.
Smell. Instead of disinfectant, the entire building smells of an aromatic oil. It has a surprisingly relaxing effect.
Sound. The environment is designed to be as quiet as possible. There are no public pages of doctors or nurses. Heating is by radiator, and air conditioning comes from the nearby sea. Therefore, there is no constant low-decibel whoosh of ventilating equipment in the background. Also missing is the babble of television.
Feel. Using the argot of the Steinerians, the building "meets the body," in a completely novel way. The stair rails are shaped to accommodate the curves of the hand. All the furnishings are custom-made. The hall floors are wood planks.
The custom lighting fixtures (a big hit with the European architects) surround the incandescent bulb with draped linen or muslin.
For the architects, many of whom were unfamiliar with the anthroposophical concepts underlying the design, the building achieved the intended effect.
"I feel much more relaxed than when I came," commented Swedish architect Catharina Jonsson, standing in the garden at the end of the tour. "My shoulders have assumed the proper position."
Indeed, the sense of restorative well-being engendered by the hourlong tour was palpable to all. The structure encourages consciousness of qualities that don't normally register psychologically in the everyday world.
"It's about as atypical of a hospital as you are likely to see," said Clare Cooper Marcus, professor emeritus of landscape architecture at the University of California at Berkeley, who was on her second visit to the site. "Notably in the shapes: the roof shapes, window shapes and use of color. It is very soothing, very quiet. And it smelled wonderful. All the things we complain about in hospitals--they're noisy, they smell of disinfectant, they're hard-edged--are absent there. This was soft-edged, comforting, quiet and relaxing. It feels like something between a spa and a church."
She's not entirely wrong, on either count. The techniques used at Vidar Klinik are the sorts of things that might be part of a $1,000-a-day luxury spa experience. The Vidar practitioners use homeopathic remedies, light treatments, special baths, music therapy, art therapy and "eurythmy"--a style of movement designed to facilitate healing.
"You work with these gestures to redirect the life force within the patient," Wessling explained. Some patients, he said, use eurythmic therapy to avert asthma attacks and migraines.
About half the patients are fighting cancer. Many others are being treated for depression, stress and various other mental ailments.
Cancer patients who need chemotherapy or radiotherapy receive those treatments at a community hospital. "We don't object to that. Some patients need chemo," said Susanna Bloomberg, chief nurse for the clinic. "But we don't want it here. That is not what we have chosen."
Anthroposophical physicians, Wessling said, think of the traditional allopathic practitioner as one who "addresses one aspect of reality, and has blown it up to the exclusion of everything else."
Anthroposophy proceeds from four essential aspects of the human being, Wessling said:
First, the physical body, with which allopathic doctors are exclusively concerned.
Second, the "etheric" body, or life-force of the patient. "A plant also has a life force, which directs its growth. The life force of a human being causes a wound to heal," Wessling said.
Third, the "astral" body, or soul. This is the locus of feelings and emotions.
Fourth, the "ego" or the consciousness. Anthroposophical medicine teaches that illness is not necessarily a problem, but an opportunity for personal growth.
The Vidar Klinic had 6,000 outpatient visits in 1998 and 710 inpatient admissions. The facility had a total of 12,100 days. Patients stay two, three or four weeks. Two weeks is the minimum.
Cost of treatment, including all therapies, is about 2,200 Swedish kronor, or $214, per day. About half of patients are covered by standard government health insurance.
The remainder either pay their own way or have private health insurance. Those paying out-of-pocket are charged about 1,500 kronor, or $146 per day.
"This is due to our philosophy that everybody should be able to stay here," said Thomas Schneider, the administrator. "Fifteen-hundred kronor a day is still quite a lot. You usually don't pay anything in the official hospitals. We then try to fill the gap by applying for money from organizations and foundations."
To show that it meets contemporary standards of medical care, the clinic has begun to measure its clinical outcomes. "Society and the government demand that we do this," Bloomberg said.
Two comparative studies are going on: one on fibromyalgia, or chronic pain syndrome, another on breast cancer recovery. "The study results have been quite good," Bloomberg said.
About 80% of the patients at the hospital are female, many of them breast-cancer patients, Bloomberg said. "Women easily try new things, especially when it has to do with the body," Bloomberg said. But the proportion of male patients is gradually increasing, she said.
At the Vidar Klinik, Bloomberg said, "We talk a lot about getting people into their bodies. Most people today are too much in their heads. We have to work to get them back into their bodies so they can fight against the disease."
Though this may sound reassuringly New Age to those who harbor a distrust of Western medicine, Bloomberg hastened to add that they do not see themselves as having much in common with alternative medicine or imported therapies.
They have no interest in acupuncture or other alternative methods. "We stick to our own thing. There is only so much you can do well," Bloomberg said.
Much of the artwork in the patient wards are reproductions of Christian imagery and iconography. Steiner endorsed the basic thrust of the Christian belief system and incorporated it into his overall philosophy.
Despite the adherence to Steiner's philosophy at Vidar, the staff doesn't use the clinic as a vehicle to pass on the belief system or to recruit new followers.
"We don't pressure the philosophy on the patients," Bloomberg said. Only if patients express an interest in learning more about anthroposophy do they get the background.
"You don't answer questions that nobody has asked you."