Change of Heart
Change of Heart: Rethinking the Prescriptive Medical Environment
A project by Marina Nicollier, produced at Rice University, 2008.

Advisors: Dawn Finley, Eva Franch Gilabert, Farès el-Dahdah, and Albert Pope

MANIFESTO
My thesis addresses the need to rethink the use of environmental qualities in medical facilities, looking to and expanding upon how they were used in past paradigms.
The human body responds to its spatial and environmental surroundings in very subtle ways. Our most basic reactions to our environment can be read, essentially, in our vital signs; yet as many of these phenomena are subtle enough to be easily overlooked without some sort of monitoring device, they have been too often dismissed as fleeting emotional and sensorial effects that have little impact on our physiological system as a whole. These qualities can do much more. They can act as an architectural base for a very important body of research, expanding beyond the limited range of possibilities imposed on them by existing models of medical environments.
We need to create spaces that provide, through their experience and material substance, enough variability in environmental effects that individual differences in reception and response can be studied and used as a part of curative regimes. The need today for experimental and preventive treatment methods requires a new approach to this symbiosis between medicine and architecture, from which new typologies should emerge.
Although these environmental factors have continually been important considerations in the design of medical facilities, the role they have played as generators of new types of experience and treatment has been limited. They have been utilized in much the same way as a prescribed medication would be: in controlled doses, allowing only for a highly regulated exposure dictated by a particular treatment regime.
Instead of continuing to implement this prescriptive paradigm in medical facilities, the spaces themselves should act as experiential platforms that provide a broader spectrum of environmental qualities, so that we may better understand their effects on our psychology—and ultimately, on our physiology.
The new experiential model will be developed as a cardiology research facility adjacent to two major medical institutions in Mexico City. A primary research area will provide a field of various environmental intensities, ranging in levels of enclosure and public interaction. Visitors to the facility are encouraged to move from environment to environment, moving around and through the different intensities of light, sound and temperature, the visitor would be able to trace their path, both spatially and in terms of the intensities they experience, as well as their cardiovascular response to the event, which is remotely monitored. With this expanded variety of experience, the data gathered in this facility will extend beyond that which is collected under more prescriptive medical environments.

THE PRESCRIPTIVE v. THE EXPERIENTIAL
This new experiential model expands upon the prescriptive model in several ways, in terms of how it relates to its architecture, environment, materiality, and location.

ARCHITECTURE
Its architectural expression is no longer component-based; rather, it relies on an experience-based design generated on a series of gradient intensities.
The prescriptive typology is perhaps best exemplified by the design of the modernist sanitarium, which sought to utilize architectural space as a sort of “medical instrument”. Popular ideas about what constitutes a healthy environment gave rise to many of the components that became the formal trademarks of modernism—the flat roof was devised as a means to provide additional sunning surfaces for tubercular patients; while the deep verandas, wide private balconies, and covered corridors served as organizational tools to isolate contagious patients from the general staff. The architecture of the prescriptive typology so prevalent in modern medical facilities was considered to be part of the treatment regimen for tuberculosis, which during the first half of the twentieth century had become a global epidemic. It was not until the 1950’s that an antibiotic was determined to be the only effective treatment for the disease, but the modernist emphasis on the curative effects of certain environmental exposures. The component-based paradigm the movement sparked retained a certain hygienic quality that the modernist sanitariums embodied.

ENVIRONMENT
The use of environmental qualities is no longer geared towards a moderated exposure, but is rather about offering a wider range of gradient intensities. The prescriptive model of the curative attempted to incorporate environmental elements into both its architectural substance and its treatment regimen. At the time that many of the modernist health facilities were being built, it was commonly acknowledged that moderate and carefully controlled exposure to sunlight and to particular altitudes and climatic conditions would alleviate some tubercular symptoms. Visits to these establishments were prescribed, as were the conditions and durations of the exposures themselves. Today, of course, there is ongoing research to determine how and to what extent environmental factors such as temperature, natural and artificial light, and sound affect our health, and despite there having been some interesting conclusions, it is still an area of research that requires more investigation and exploratory trials.
An experiential model facilitates this type of research by expanding the range of environmental variables. The participant is encouraged to experience as wide a range of conditions as possible so that the effects of these conditions can be studied.

MATERIAL
The experiential model also uses materials in a different way. Materiality was neutralized by the prescriptive model in order to create hygienic, easy-to-clean surfaces; thus a material language of white concrete and steel structure became standard issue in modernist medical facilities. The experiential model seeks to use materials to work with the environmental intensity of a space—by amplifying and diversifying existing conditions, or functioning as a source for new ones.

LOCATION
Most sanitariums and health resorts designed with the prescriptive paradigm have specific needs regarding their site. Their regime of exposure to light, temperature, and clean air limited called for very particular climatic conditions falling within acceptable ranges. This is why the vast majority of these facilities were built in remote, rather idyllic locations near the coast or tucked away in alpine forests, away from any urban centers, which were considered to be too dense and dirty to be of any use for a treatment regime. And considering that accessibility is important to any curative facility, the new experiential model is freed from these limitations.

By allowing for a gradient system of environmental factors (including that of interior-exterior relations), the experiential model can exist in a large city, even one located outside temperate climatic zones. A combination of natural and artificial systems thus supplements the environmental qualities of the city, incorporating them into its intensity gradients.

The modernist sanitarium regarded environmental qualities as essential considerations in its architecture as well as its curative regimes. The proposed experiential model does as well, but expands beyond using them in a prescribed way. As there is still much to be learned about how the body responds to its environment, and the repercussions of this response on general health—so this model places these investigations at the root of its design.

Located on the campus of the Hospital General de Mexico in the medical district of Mexico City, the proposed facility serves an intermediary function between the hospital and the national university’s department of experimental medicine, located just adjacent to the site. Visitors to the hospital—those attending appointments as well as those waiting for family members—will be provided a place to spend time while serving an important role as subjects in the medical research community. Upon entering, a visitor will be outfitted with a vital sign monitoring device that wirelessly communicates their physiological information to researchers at the facility. The device receives information on the visitors ECG, heart rate, skin temperature, and posture, among other indicators. Then the visitor is free to wander the primary research floor of the facility, which is made up of a series of enclosed, semi-enclosed, public, and semi-public environments of varying temperature, sound level, and light. By moving through these spaces, the visitor relays valuable information to and through the building itself, acting as the focus of the experiential model.
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