In 1983, a groundbreaking study was published demonstrating that architectural environment influences recovery from surgery. Benedetti describes the placebo as “the whole ritual of the therapeutic act”, so why shouldn’t that also include the clinical environment? In this article, we explore the 1983 study and the interrelationship between the placebo effect and architecture.

A hospital in Pennsylvania

The study focussed on patients in a hospital in suburban Pennsylvania between 1972 and 1981. All the patients were recovering from surgical removal of their gall bladder (cholecystectomy). The hospital itself has a series of rooms which are nearly identical in dimension, window size, arrangements of furniture and other physical characteristics. The windows are of equal size and equal distance from the floor allowing an unobstructed view outside. The only difference is what can be seen through the window, with some windows showing a natural scene, and others showing a plain brick wall. The study reviewed its records to identify if having a natural view from a hospital bed would affect recovery.

Plan of the second floor of the study hospital showing the trees versus the wall window views of patients. Data were also collected for patients assigned to third-floor rooms. One room on each floor was excluded because portions of both trees and wall were visible from the windows. Architectural dimensions are not to scale. (image and caption copied from original paper)

The Patients

To account for the natural variability within the patient population, to be included, all patients had to meet the following criteria:

  • Must have undergone cholecystectomy between 1st May and 20th October, as the amount foliage on the trees may have had an effect upon results.
  • Must be aged between 20 and 69 years.
  • Must not have experienced serious complications as a result of their surgery or aftercare.
  • Must not have a history of psychological disturbances.

The patients were then matched into pairs, one with a natural view, the other with a view of a brick wall. The patients were paired up using the following criteria:

  • Of the same sex
  • An age gap of no more than 5 years
  • Smoking status
  • Obese or normal weight
  • General nature of previous hospitalisations
  • Year surgery was conducted (within 6 years of each other)
  • Floor level (patients on the second and third floors were included)
  • Colour of the room (rooms alternate between blue and green)

The Data

An experienced nurse extracted the data from hospital records without knowing which view the patient had from their window. The types of information taken were:

  • Length of hospitalisation (day of surgery to day of discharge)
  • Number and strength of analgesics (painkillers) administered each day
  • Number and strength of anxiety medications, (tranquillisers and barbiturates) administered each day
  • Minor complications, such as persistent headache, nausea that required medication etc.
  • Nurses notes relating to patient’s condition and course of recovery. These notes were then classified as positive or negative.

The Results

The results showed that there were no significant differences between the following criteria:

  • Analgesic use on days 0-1 and 6-7 post surgery.
  • Anxiety medication
  • Minor complications
  • Number of positive nurses notes
CriteriaNatural ViewWall View
Average length of hospitalisation per patient7.69 days8.70 days
Average no. & strength of daily analgesics dose (days 2-5)Strong = 0.96
Moderate = 1.7
Weak = 5.36
Strong = 2.48
Moderate = 3.65
Weak = 2.57
No. of negative nurses notes per patient1.13 notes3.96 notes

The results demonstrate that patients with a natural view recovered more quickly and required less moderate or strong pain medication than those with a wall view. In addition, patients with a natural view received fewer negative nurses notes.

Conclusion

The results suggest that a natural view is beneficial to patients, improving their recovery time and reducing their pain or the level of pain medication they feel they need. It should be mentioned that in this particular study, the wall view was a comparatively monotonous view, whereas the natural view was more stimulating. It is not known whether these results scale up to all views of natural or built environments.

This study set a premise for more research into the effects of health on built environment. Unfortunately, there has been little more research done in the last 3 decards since this study was originally published. However, some hospitals are starting to embrace the idea of a natural view for their patients where they can. Butaro District Hospital by MASS Design Group consciously provides patients with a natural view from large windows in front of each bed.

Is this the placebo effect and architecture?

As we mentioned earlier, the placebo effect is “the whole ritual of the therapeutic act”. Taking this into account, it is highly likely that this research demonstrates one way in which architecture can induce or support the placebo effect in patients.

We hope that the next few decades show more research into the placebo effect and architecture and a greater awareness of how architectural environment can affect health.

Further Reading

You can find the original study here.

If you’re interested in how architectural environment can affect health, we’d recommend reading Esther Sternberg’s ‘Healing Spaces’ and Anjan Chatterjee’s ‘The Aesthetic Brain’.

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