Zdravotnictví
by Bill Witherspoon
"Only nature heals, provided it is given the opportunity to do so."
Hippocrates, the father of medicine, wrote these words in ancient Greece. Now, 2,400 years later, in the context of an explosion of medical technologies, it remains clear, both scientifically and intuitively, that the single most important element in the healing process may still be nature. "Nature heals" has yet to be replaced by "man heals" or "technology heals." Nowhere is this principle more important than in the profound developments that are occurring in radiological practice. The diagnostic and therapeutic tools of modern day radiology are changing the face and outcomes of medical practice profoundly. But for the uninitiated patient, often overwhelmed with anxiety and fear, the technologies and procedures of radiology are at best mysterious, and at worst, cold, removed, and even terrifying.
With the experience of the patient in mind, it is no wonder that thoughtful healthcare facilities and their designers are currently engaged in a serious effort to reintroduce the experience of nature into radiology. However, of all healthcare environments, the radiology suite is one of the most difficult to integrate into the natural world through an architectural design that utilizes gardens, windows, and skylights. But are there some effective alternatives?
For several years, images of nature, often presented in backlighting systems, borrowed from the sign and display industries, have been used in radiology facilities in the hope that such images will help improve the environment. This has had a measure of success as reported by patient satisfaction surveys and legitimate research. The next step goes beyond the display of beautiful images of nature to the deliberate creation of powerful illusions that can reliably trigger an authentic experience of nature and the psychological and physiological correlates that accompany such an experience.
The key to harnessing illusion lies in understanding our habits of perception. A magician creates a completely believable (though unreal) reality through skilled manipulation of our perceptual habits. Similarly, the architect or designer of an imaging suite must analyze our habits of perception to create architectural design elements that lead us beyond a mere idea to an authentic experience of nature.
New technology, as well as new understanding of human perception, has paved the way, and we find more and more of our sensory input carefully designed to achieve specific results. This is occurring everywhere in our information-laden environment. Consider for example, the ability of technology to create virtual realities. Whether it's the sound system of a modern theater that can now place a whispering voice six inches behind the right ear of every movie viewer, or a pair of high-tech "goggles" that present us with an entire new world of sight and sound - the key lies in the ability to successfully trigger powerful psychological and physiological responses through manipulation of sensory habits of perception.
To move beyond beautiful pictures to a virtual reality that provides an authentic experience of nature, one must consider two basic elements: appropriateness and/or content of the natural subject matter; and specific techniques for engaging our habits of perception to generate an experience of the real. We all love and appreciate nature, yet some of us are "mountain people," whereas others prefer the ocean or the desert. However, we all love and appreciate the sky without reservation. It is not only universal and pure, but it is also our most expansive and significant exposure to nature throughout life.
Consider then, building an illusory sky in the ceiling above the patient.
To begin with, the purpose of making an illusory sky ceiling in a healthcare facility is to trigger the psychological and physiological response that an observer would automatically have when lying on the ground looking up into a beautiful sky. We all know the experience and we all know the result - deep relaxation, freedom, and inner peace.
It's not simple to create an illusory sky that has sufficient power to trigger the desired response. This is in large part because, whether we know it or not, the eye and mind is highly tuned and alert to the tremendous amount of information that is present in a real sky.
For example, because sky color is directly correlated with altitude, temperature, humidity, barometric pressure, and pollution - the color seen by the observer will convey considerable information. Specifically, a violet-blue sky is characteristic of a high-pressure front (or high-altitude) and elicits a different experiential response than the softer high-humidity yellowish-blue of a low-pressure front. We simply feel better in the high-pressure, low humidity conditions and experience has taught us to associate that "feeling good" with the corresponding hue range of violet-blue.
Clouds have no intrinsic color, so their apparent colors are imparted by the atmospheric qualities previously discussed, as well as the angle of the sun, the time of day, and the complexities of internal shadowing. Their physical structures and patterns of formation are also built according to complex interactions governed by the basic laws of fluid dynamics and thermodynamics. As a result, considerable information about how the world works is embedded and available in something as apparently simple as the form, pattern, and color of clouds.
Virtually all clouds and their transformations occur in orderly arrangement. It should be no surprise that clouds display the same patterns that can be observed elsewhere in the world. A sky of rippling clouds is little different from the rippling patterns in a sandy river bottom, from the eddies of blood in the aorta, or the centuries old erosion patterns of the Southwest as seen from the air.
In the presentation of a sky ceiling, there are several perceptual habits that must be considered to create a successful illusion. Correct perspective is one of the more important. When we look up into clouds we see only the bottom of clouds that are directly above and see increasingly more of the sides of clouds as our view moves from zenith to horizon. Therefore, the straight up view appears very different than an oblique view. In fact, even when we look up into an empty blue sky, it is never a uniform blue of constant luminosity, but is always graded in hue and value from horizon to zenith.
Consider, for example, a sky ceiling that is approximately six feet above a reclining observer's head and displays a flat photographic image of sky that covers an area two feet wide and six feet long - with one end of the sky image above the head and the other above the feet. If the zenith in the image is located directly above the observers head and the sky above the feet is the view about fifty degrees towards the horizon, then the observer in this situation will see exactly what would be observed if an identical hole were cut in the ceiling and a real three dimensional sky passed overhead. However, if the flat image of the sky is reversed with the zenith above the feet, then the observer's view is "wrong" and the response is quite different.
In an informal experiment, thirteen observers were placed beneath such a 2'x 6' flat ceiling sky image installed in an eight-foot ceiling. At each end of the image, about one-third showed a portion of white cloud, while the middle-third was open blue sky. The sky image was designed to place the zenith at one end of the installation. The observers' first viewings were with their feet beneath the zenith - in other words oriented "incorrectly." All observers were pleased with the image, commented on its novelty, and indicated that it was pleasant. Everyone thought it was a great idea.
In the second phase of the experiment, the image was installed "correctly," though the change was not immediately obvious because of the almost symmetrical masses of white cloud at each end. In all thirteen cases, the experience was reported as being considerably different with many of the observers puzzled by what had caused the change. Only two people noticed that the image had been rotated 180 degrees. All expressed their changed experience in terms of a greater perception of space or depth and increased realism. All observers indicated that something significant had changed in their subjective experience as well. They became quieter, were more absorbed in the experience, looked longer, and described a more powerful subjective inner experience.
Most related this illusion to the childhood experience of lying on their back and looking up into the sky. In some cases, the experience was likened to the inner experience of expanded peacefulness that occurs in meditation. After the second viewing, the prevailing remarks shifted from discussion of the idea of a sky ceiling to that of the experience of a sky ceiling. This indicates the discriminating power of the mind and eye, and their link to subjective experience.
There are other factors related to our perceptual habits that must be considered when one attempts to create an illusory sky that will actually trigger the desired psychological and physiological response.
- One might be tempted to use a wide-angle lens in photographing the sky. However, the curvature and forced perspective that can be seen in converging trees, and even clouds, alerts the eye and mind to the fact that what is being observed is, in fact, a photograph - not sky.
- Blurring of motion is a convention of photography - not of our vision - and alerts mind and eye to the unreality of the image.
- Use of a reflective surface alerts the eye and mind to the existence of a plane that is located in the ceiling and hence conflicts with the illusion of deep space.
- In spite of a beautiful image, it is difficult for the mind to accept a field of blue sky that is marred by the subtle, but telltale hot-spot stripes of old style fluorescent backlighting. New advances in edge-lit technology can eliminate this problem.
- The quality of light used in backlit or edge-lit systems provide its own set of cues - conventional fluorescent or incandescent delivers a much different message than 6500 Kelvin, "daylight."
This light source triggers a daylight experience - hence its use for the treatment of Seasonal Affective Disorder (SAD). When one considers the benefits to health and productivity of such light and the fact that staff spends most of their daylight hours under the artificial illumination of the suite and control room, the use of 6500 Kelvin becomes doubly important and of significant benefit to them as well. - The size and placement of a sky ceiling, in addition to being a focal point for the observer, should also engage their peripheral vision to utilize the unique perceptual attributes associated with that mode of vision.
- The use of a grid (such as the extrusion that supports a true skylight or a ceiling grid system) might at first thought seem disruptive, but in fact, because of the perceptual habits developed by years of exposure to grids in windows and door, grids actually signal the eye and mind to read the space on either side as "beyond." This significantly enhances the experience of space and contributes to the reality of the illusion. The repeated underlying principle is that mind and eye-operating independently of the intellect - are highly sensitive and linked to a vast repository of information that is continually being collected and updated as a requirement for successfully navigating in the sensory world. For the sake of efficiency, much of that ongoing process has been relegated to habit, and it is by virtue of understanding these habits that we can maneuver the mind/body into the desired experience and outcome.
There is no reason why a successfully implemented sky ceiling should not be affordable. Utilizing the powerful illusionist approach, executing with the newest lighting and imaging technologies and modular ceiling grid systems, one can provide an authentic experience of nature for patients and staff alike. The cost in a midsize radiological facility of an optimal installation is approximately $.35 per patient procedure when amortized over three years. In an MRI that uses new LED RF-free lighting technology, the cost would be approximately $.56 per patient procedure. Considering the benefits of patient comfort and loyalty, as well as referrals and the improvements to staff well being and health, the utilization of this technology to bring the vastness of the sky inside seems appropriate.
To conclude, it seems worthwhile to explore technologies that can engage awareness in the experience of fundamental laws and forces of nature, and thereby produce the psychological and physiological states of reduced anxiety and restfulness that correlate with this experience. Furthermore, given the constraints that must necessarily exist in healthcare structures, the thoughtful use of illusion may well assist in the practical introduction of the benefits that follow from an authentic experience of nature.
