SCIENTIA MORALITAS CONFERENCE PROCEEDINGS

DOI:10.5281/zenodo.10718707

Aspects of Healing Space in Social Reforms

Ovidiu Carțiș
University „Aurel Vlaicu” of Arad, Romania,
Interdisciplinary PhD School, [email protected]

ABSTRACT: Healing space is a complex concept that has become a targeted problem in the healthcare
system and overall therapy all over the world in the last two decades. From ancient times, healing spaces
were an active preoccupation of people. The fire dances and storytelling were therapeutic. Greeks
constructed a healing city in Epidaurus, and sacred spaces were found all over the world. In modern times,
there has been a growing interest in the last two decades in enhancing the healing process using
environmental design elements, cultural elements and spiritual dimension. Nature and physical activities
like tending horses or gardening, architectural elements, sunlight, air, integration of technology and healthy
relationships like nurse-patient, therapist-patient or family relationships are key ingredients to cultivate
rapid health recovery. A patient-centered holistic healing perspective is considered in the healthcare system
and therapy. This study analyzes the various aspects of healing space, emphasizing its relevance in the
context of social reforms in healthcare and therapy.
KEYWORDS: healing space, sacred space, healing environment, art therapy, patient-centered healing

1. Introduction

Health was one of modernism’s central motifs, from the improvement of the built environment and
the formulation of the aesthetic theory to the institution of social reform (Schrank and Didem 2016,
1). Considering the well-being of human beings, almost everything matters in order to create a
space for healing: the physical elements of the room, the noise, the light, the air, nature view, and
physical activities. Healing Space is described in terms of the physical attributes of the space, the
feelings that the space evokes, the familiarity of the space, its relationship to nature, spiritual or
religious significance, and as a space where people feel cared for by attentive staff (MacAllister,
Bellanti and Sakallaris 2016, 123).
Recently, the design for healthcare environments has begun to include esthetic
enhancements in order to reduce stress and anxiety, increase patient satisfaction and promote health
and healing. Recent research created a hierarchy of effects of environmental elements ranging from
nontoxic to safe (both physically and psychologically) to the one that provides a positive context
and is actively salutogenic (Schweitzer, Gilpin, and Frampton 2004). Despite knowing the role of
design and the built environment in creating health and well-being, there is not enough attention
given to this fundamental aspect (Yeang and Dilani 2022, 88).

1.1. Healing space in antiquity

Sacred space has been a well-known healing environment for body, mind and soul since antiquity.
In the fifth century BCE, Greeks built a healing city at Epidaurus. While the primary healing
activity took place in the Asklepian temple, the entire city was utilized as a healing environment;
they used two evidence-based principles of modern healthcare design: views of nature and the
incorporation of light. Other buildings part of the healing journey in Epidaurus were the baths (for
purification, relaxation, and hygiene purposes), the Abaton (for dream healing), Theater (for
overcoming adversity), stadium (viewing athletes compete, overcome adversity, for communal
bonding), gymnasium (for physical exercise), monuments (testimonials) for pilgrim cure,
worshipping the gods and goddesses and the banqueting hall (meals, baths, exercise). [fig. 1]
SCIENTIA MORALITAS CONFERENCE PROCEEDINGS, February 15-16, 2024 128

Figure 1. Image of the theater at Epidaurus, Greece. (A) This image is of the ruins of the Abaton,
the place where sleeping or “incubation” and dream healing occurred at Epidaurus, Greece (Photo Credit:
Anton Ivanov-Shutterstock); (B and C) image of the theater at Epidaurus, Greece (Photo Credit:
Kotsovolos Panagiotis-Shutterstock)

Later in Japan, the tea ritual was used for healing traumatized warriors during the civil wars
in Kamakura Period (1185-1392) (Alt 2017, 284-7). [fig. 2]

Figure 2. Japanese tea garden pavilion at the Chicago Botanic Gardens

SCIENTIA MORALITAS CONFERENCE PROCEEDINGS, February 15-16, 2024 129

1.2. Healing space and cultural elements

Storytelling is an ancient way of healing, like music, especially around fire. Navajo coyote tales
are examples of stories that make people laugh and teach people how to behave, but are a medicine
intended to knit things together (Saliba 2000, 38).
In Canada’s healthcare system, expecially in rheumatology, there is an active interest in
including indigenous healing practices for indigenous patients (Logan et al. 2020, 5). In Mexico,
cultural arts create healing space for Mexican youth (children) who live mixed-status experiences,
especially chronic fear (Hernandez-Arriaga 2017, 2). Art therapy is founded on the belief that the
creative process involved in the making of art is healing and life-enhancing. Art therapists are
professionals trained both in art and psychotherapy (Ferrara 2004, 3).

1.3. Healing Space in therapy

Healing space is needed in psychotherapy sessions considering the healing relationships between
therapist and client (Elsass 1993, 333-42). Psychologist Adwoa Akhu shares thoughtful design
suggestions as well as meditations and rituals rooted in African and multicultural traditions that
enable to create serenity and positivity in living places and therapist cabinets (Akhu 2016). “True
healing is not a state where we become liberated from feeling, but freer and flexible to experience
it more fully,” writes Dr. Matt Licata. “When we experience our suffering consciously, it reveals
sacredness and beauty we might not expect. Healing will always surprise us” (Licata 2020).
Numerous projects for the integration of technology in therapy have been conducted in the
last two decades. One of them is Healing Spaces at the University of Southern California’s
Interactive and Games Division. This is a project as part of Gabriela Gomes`s Master of Fine Arts
thesis work. It is used for older adults suffering from advanced dementia where healing spaces
prove to ameliorate the behavioral and psychological symptoms (Gomes et al. 2020, 1-2) [fig. 3]

Figure 3. Forest environment brought to life in the physical space

Image credits: Gabriela Purri R. Gomes

2. Healing space and elements of an optimal healing design

The healthcare system was focused primarily on healing the body, but we now have a growing
recognition that the healthcare system could promote and achieve holistic healing. There are six
groups of environmental variables that have proven to directly affect or influence one or more
dimensions of healing. These variables are: homelike environment, access to views and nature,
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light, noise control, barrier-free environment and room layout. It seems that healing spaces have
power over body, mind and spirit (DuBose et al. 2018, 43-56).
Nature. One good way of self-healing is using gardening. Tending the garden - from
clearing to planting to harvesting - becomes a metaphor for cultivating the soul in Marilyn Barrett's
evocative "Creating Eden." In the lovely and moving essays gathered together here, Barrett invites
us into the healing space she created in her own backyard, encourages us to create our own places
of beauty and peace, and shows us how, in a time of illness and stress, she used gardening to restore
her health and balance. And she shows us how any garden - be it a window box of herbs or garden
of the imagination - can yield a harvest of serenity (Barrett 1997).
Another example of self-healing using nature is Esther Sternberg. Gail Sheehy said about
her: "Esther Sternberg is a rare writer—a physician who healed herself…With her scientific
expertise and crystal-clear prose, she illuminates how intimately the brain and the immune system
talk to each other, and how we can use place and space, sunlight and music, to reboot our brains
and move from illness to health."
In recent years, natural healing space studies have been done in health and forestry (Park
and Lee 2016, 75). Green spaces, whether urban or forest, have an increased potential for healing
regardless of culture or location (Engineer, Ida, and Sternberg 2020, 3). The health of the
environment is closely linked to personal health. A researcher in the 1980’s observed that patients
with a view to nature healed faster than those without. So, designing hospitals, communities, and
neighborhoods that promote healing and health for all could be the future in healthcare (Sternberg
2009). High dense urban environments create stress from noise and crowding and affect mentally
and physically the people living especially in South Asia over-crowded cities like Hong Kong and
Singapore. The solution is creating indoor and outdoor healing factors in environment design (Xue
and Gou 2018). In Guangdong province, China, a study of the landscape environment in 10
hospitals showed that participants need a quiet place, safe and private environment that includes
visual healing, rehabilitation activities, shading and heat preservation and medical escort (Guo et
al. 2023, 1).
Air. Improving Indoor air quality (IAQ) is one of the goals of the UN (United Nations). So
proper cleaning staff training is necessary because the use of chemicals in energy strategies creates
pollution risks (Gola, Settimo, and Capolongo 2019, 2).
Sunlight. In the nineteenth century, sunlight and open windows were thought to be the most
effective means of purifying the air and killing the bacteria causing tuberculosis. In the first part of
the twentieth century, architects who designed homes and hospitals took advantage of the sun in
order to create a healing space (Sternberg 2009, 4-5).
Relationships. Healing appears as a deeply personal experience that emerges from a
suitably fertile, relational, social, biological, and cultural ecology, a healing landscape, and is not
limited to particular clinical encounters and/or healthcare sites (Miller and Crabtree 2005, 42).
Miller tells the story of a man who contracted AIDS and found the healing landscape only when
he found a doctor who accepted him as he was. Encouraged by his sister to live in order to take her
to the altar when she would get married, this man reconstructed his personal (new room
environment) and professional life (healthy relationships with boss and coworkers). The
constellation of elements that combined create the healing landscape is formed from multiple
healthy relationships, environmental elements and healing places.
The concept of the environment has been considered central in nursing`s paradigm, so the
nurse`s place in client-environment process is rather with the client in order to pattern the
environment that promotes healing and comfort (Quinn 1992, 26). The patient and the practitioner
are both notes of the same sheet of music (Perri 2014, 16).
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Physical activities. In 2008, inadequate physical activity was the cause of over 3.2 million
deaths worldwide and now is considered the fourth primary cause of mortality and significant
contributor to societal health loss (Marques, McIntosh, and Kershaw 2019, 20). Only both hardship
and joy can lead us back to the sacredness of ordinary life (Licata 2020), restore relationships and
create a healthier environment for a better social life.

2.1. Healing spaces for youth and children

Nature, color, noise, music, lighting, spatial crowding, art, and physical environment impact the
well-being and healing in pediatric healthcare, but is needed to contextualize and separate the
design variables so the individual and combined impacts reflect holistic design recommendation
(Gaminiesfahani, Lozanovska and Tucker 2020, 99).
Spatial experience was evident in the architectural practice of the ancient world. There were
developed four examples of architecture specialized in healing young adults and children (Asfour
2020, 133). McGill University Health Centre states that patient and family are central to
participation in the healing process "the built environment is a tool in the healing process in order
to complement and enhance the skills, expertise, caring dimension and high-tech support of
caregivers." This declaration reflects a growing acceptance of the notion that a human centered
approach and the quality of hospital space are now considered very important for medical care
outcomes. San Diego Children Hospital's official recently admitted: "design is now an essential
strategic element for our future" (Risse 2003, 2).
The young black people need, according to some studies, a healing place of refuge in order
to reconcile, confront and heal from psychic wounds (Brown 2016, 283). In 2008, the Canadian
government invested 250.000 $ in a program that aimed to assist youth in trouble with the law to
recover from illicit drug abuse. Tending horses was involved. Three key themes showed the
capacity to heal: spiritual exchange, complimentary communication and authentic occurrence (Dell
et al. 2011).

2.2. Healing spaces for elderly people and veterans

For elderly persons, the therapeutic landscape contains connection to public green space and
physical exercises in nature that are part of a targeted design which facilitates accessibility,
inclusivity and sociability (Marques, McIntosh, and Kershaw 2019, 29).
Veterans have high rates of physical, mental and behavioral health challenges as well as
higher cronic pain, so the Veterans’ Health Administration (VHA) shifted from a traditional
healthcare to a Whole Health (WH) approach in order to provide personalized and holistic
healthcare experience for veterans mainly with gardening activities and agriculture (this was a
practice for soldiers to work in hospital gardens since the end of World War 1) (Besterman-Dahan
et al. 2021, 1). Places that are used today in healing using their history are: The Brion Tomb, San
Vito d`Altivore, Italy, Du Sable Urban Ecology Sanctuary (unbuilt), Chicago, Illinois and The
Veterans Memorial Building, Cedar Rapids, Iowa (Alt 2017, 289-291).

2.3. Healing space and spiritual dimension

In addition to the contribution of healing spaces, there is a spiritual contribution that through prayer
the sick can find healing. The history of divine healing is very vast, starting from biblical times,
but we have recent testimonies that confirm healing in healthy physical, emotional and spiritual
environments. In 1876, Miss Harriet M. Barker, while attending the nation’s centennial celebration,
contracted typhoid, and in a few years, her condition was declared incurable. But in time of sickness
in her healing space at home, she found the way to life and healing by praying to God (Curtis 2006,
SCIENTIA MORALITAS CONFERENCE PROCEEDINGS, February 15-16, 2024 132

598). Equally, if not more important, many women were responsible for the health of their
household, diagnosing, prescribing and preparing medicines at home. We will never know the full
extent of women's healthcare practice in early modern England, but women were a substantial
portion of practitioners (Fissel 2009, 153). After more than a century from Azusa Street revivals
and the shift in the landscape of Christian healing practices, alongside unprecedented achievements
in medical science, nearly 80 percent of Americans report believing that God supernaturally heals
people in answer to prayer. Individuals who need healing, even after trying the best medical cures,
readily transgress ecclesiastical, physical, and social boundaries in their quest for health and
wholeness (Brown 2006 631).

3. Conclusions

Environmental elements are considered important to create a healing space in these modern times,
an era of high-density cities and a need for social reconnection. Nature view, physical activities,
air quality, noise moderation, sunlight’s healing power and healthy nurse/doctor/therapist-patient
relationships have an important impact in designing the optimal healing space, considering cultural
and spiritual dimension in a holistic healthcare approach. The contribution of faith (Rotaru 2012,
5) remains an important point in this healing landscape that integrates the healthcare system,
therapy, cultural contribution and spiritual dimension (Rotaru 2017, 57-76). Even from antiquity,
people were concerned in the restoration of body, soul, mind and spirit. Storytelling and fire dances
were part of primitive therapy. Healing centers were built, like healing city of Epidaurus, in ancient
Greece. Japanese had tea ritual in garden pavilions for healing traumatized soldiers, later, tending
the hospital gardens were therapy for soldiers from World War 1 and 2. Gardening, art therapy,
environment and cultural elements could be factors that enhance well-being and health recovery.
This study emphasizes the need for a thoughtful and patient-centric approach in designing
healthcare environments, considering that the healing landscape is very vast and could include
some of the elements presented above in a unique combination for each person.

References

Akhu, Adwoa. 2016. Creating Healing Space. CreateSpace Independent Publishing Platform.
Alt, Paul L. 2017. “Sacred space and the healing journey.” Ann Palliat Med 6(3): 284-296.
Asfour, Khaled Sayed. 2020. “Healing architecture: a spatial experience praxis.” International Journal of Architectural
Research 14(2): 133-147.
Barrett, Marilyn. 1997. Creating Eden: The Garden as a Healing Space. San Francisco: HarperSanFrancisco.
Besterman-Dahan, Karen, Bradley Sarah, Arriola Nora & Downs, Kiersten. 2021. “Blocking out the rabbit holes: Photovoice
and Community Gardening as a Healing Space for Veterans.” Wellbeing, Space and Society 2. DOI: 100061.
10.1016/j.wss.2021.100061.
Brown, Aishia Ayanna. 2016. “Healing spaces of refuge: Social justice youth development, radical healing, and artistic
expression for black youth.” PhD diss., University A&M, Texas.
Brown, Candy Gunther. 2006. “From Tent Meetings and Store-Front Healing Rooms to Walmarts and the Internet: Healing
Spaces in the United States, the Americas, and the World, 1906–2006.” Church History 75(3): 631–47. DOI:
10.1017/S000964070009867X.
Curtis, Heather D. 2006. “Houses of Healing: Sacred Space, Spiritual Practice, and the Transformation of Female Suffering
in the Faith Cure Movement, 1980–90.” Church History 75(3):598–611. DOI: 10.1017/S0009640700098656.
Dell, Colleen Anne, Darlene Chalmers, Nora Bresette, Sue Swain, Deb Rankin & Carol Hopkins. 2011. “A healing space:
The experiences of first nations and Inuit youth with equine-assisted learning (EAL).” In Child & Youth Care
Forum 40:319-336. DOI:10.1007/s10566-011-9140-z.
DuBose, Jennifer, Lorissa MacAllister, Khatereh Hadi and Bonnie Sakallaris. 2018. “Exploring the Concept of Healing
Spaces.” HERD: Health Environments Research & Design Journal 11(1):43-56. DOI:10.1177/1937586716680567
SCIENTIA MORALITAS CONFERENCE PROCEEDINGS, February 15-16, 2024 133

Elsass, Peter. 1992. “The Healing Space in Psychotherapy and Theatre.” New Theatre Quarterly 8(32): 333–42. DOI:
10.1017/S0266464X00007120.
Engineer, Altaf, Aletheia Ida, and Esther M. Sternberg. 2020. "Healing Spaces: Designing Physical Environments to
Optimize Health, Wellbeing, and Performance" International Journal of Environmental Research and Public
Health 17(4): 1155. DOI: 10.3390/ijerph17041155.
Ferrara, Nadia. 2004. Healing Through Art: Ritualized Space and Cree Identity. Montreal: McGill-Queen's University
Press.
Fissell, Mary E. 2009. “Women in healing spaces.” In The Cambridge Companion to Early Modern Women's Writing:153-
164. Cambridge: Cambridge University Press. DOI: 10.1017/CCOL9780521885270.011.
Gaminiesfahani, H., Lozanovska, M., and Tucker, R. 2020. “A scoping review of the impact on children of the built
environment design characteristics of healing spaces.” HERD: Health Environments Research & Design Journal
13(4): 98-114.
Gola, Marco, Gaetano Settimo, and Stefano Capolongo. 2019. "Chemical Pollution in Healing Spaces: The Decalogue of
the Best Practices for Adequate Indoor Air Quality in Inpatient Rooms" International Journal of Environmental
Research and Public Health 16 (22): 4388. DOI: 10.3390/ijerph16224388.
Gomes, G. P. R., Rubin, S., Duker, L. I. S., Benton, D., Kratky, A., Chen, S. Y. A., ... and Gotsis, M. 2020. “Healing spaces:
feasibility of a multisensory experience for older adults with advanced dementia and their caregivers.” In Proceedings
of the 13th ACM International Conference on Pervasive Technologies Related to Assistive Environments 1-9.
Guo, Haoxu, Zhou Weiqiang, Lai Wenbo, and Yao Lihao. 2023. “What landscape elements are needed for hospital healing
spaces? Evidence from an empirical study of 10 compact hospitals.” Front Public Health 11.
DOI:10.3389/fpubh.2023.1243582.
Hernandez-Arriaga, B. 2017. “There is a Monster in my House, Cultura Cura Uncovering 11 Milliones de Sueños:
Understanding the Emotional and Psychological Experiences of Undocumented and Mixed-Status Youth and
Finding Healing Spaces”. PhD diss., University of San Francisco.
Licata, Matt. 2020. A Healing Space: Befriending Ourselves in Difficult Times. Louisville: Sounds True.
Logan, L., McNairn, J., Wiart, S., Crowshoe, L., Henderson, R., & Barnabe, C. 2020. “Creating space for Indigenous healing
practices in patient care plans.” Canadian medical education journal 11(1):5.
MacAllister, Lorissa, Dawn Bellanti, and Bonnie R. Sakallaris. 2016. “Exploring inpatients' experiences of healing and
healing spaces: A mixed methods study.” Journal of patient experience 3(4):119-130.
Marques, B., McIntosh, J., & Kershaw, C. 2019. “Healing spaces: Improving health and wellbeing for the elderly through
therapeutic landscape design.” 3:20-34.
Miller, W. L., and Crabtree, B. F. 2005. “Healing landscapes: patients, relationships, and creating optimal healing
places.” Journal of Alternative & Complementary Medicine 11(supplement 1):41.
Quinn, Janet F. 1992. “Holding sacred space: The nurse as healing environment.” Holistic Nursing Practice 6(4): 26-36.
Park, S. A., and Lee, M. 2016. “An analysis of the healing effects by types of forest space-Focused on psychological
restorativeness and satisfaction.” Journal of the Korean Institute of Landscape Architecture 44(4): 75-85.
Perri, Vincent L. 2014. The Healing Space: Understanding the True Nature of Inner Healing. Irvine: Universal Publishers.
Risse, Guenter. 2003. “Humanizing Hospital Space: A Revolution in Health Care Design.” Conference: Form and Function:
The Hospital-International Network for the History of Hospitals At: Montreal, Canada.
Rotaru, Ioan-Gheorghe. 2012. “Biserica lui Dumnezeu, sursa unui Râu al Vieţii şi al Vindecării” [The Church of God, Source
of a River of Life and Healing]. Argeşul orthodox XI, 564: 5.
Rotaru, Ioan-Gheorghe. 2017. “Misiunea Bisericii în societate” [The mission of the Church in society]. Timotheus –
Incursiuni Teologice Tematice 4, 2: 57-76.
Saliba, Mediha F. 2000. “Story Language: A Sacred Healing Space.” Literature and Medicine 19(1): 38-50. DOI:
10.1353/lm.2000.0012.
Schrank, Sarah and Ekici Didem. 2016. Healing Spaces, Modern Architecture, and the Body. Abignon: Taylor & Francis.
Schweitzer, Marc, Gilpin, Laura, and Frampton, Susan. 2004. “Healing spaces: elements of environmental design that make
an impact on health.” Journal of Alternative & Complementary Medicine 10 (Supplement 1):71.
Sternberg, Esther M. 2010. Healing Spaces. Harvard University Press.
Xue, Fei, and Zhonghua Gou. 2018. “Healing Space in High-Density Urban Contexts: Case Studies and Design Strategies.”
In Handbook of Research on Perception-Driven Approaches to Urban Assessment and Design, edited by Francesco
Aletta and Jieling Xiao, 489-507. Hershey, PA: IGI Global. DOI: 10.4018/978-1-5225-3637-6.ch021.
Yeang, Ken and Alan Dilani. 2022. Ecological and Salutogenic Design for a Sustainable Healthy Global Society. UK:
Cambridge Scholars Publishing.