Psychological Design

How the environment triggers action?

“We all knew that corner was a black-spot. If ever there was violence in the (psychiatric) unit it was always there.” My guide was leading me through a corner of a psychiatric facility, where he’s a senior psychiatrist. “This corner was too compressed. And under the gaze of the staff station, patients couldn’t stop themselves from lashing out. I knew it was the architecture – but the idea that a corridor could cause serious violence was too much for the administration to comprehend. So I started to call it the ‘Corridor of Death’. And reported every new attack as an event in the ‘Corridor of Death. After a while that’s what people called it, and only then did Admin recognize the problem was with the corridor. Eventually they opened it up by knocking out a wall and put in a living space. It still has the nasty staff station, but it’s much better. Violence doesn’t happen there anymore.”

People have difficulty believing that an architectural layout can determine the choices people make, especially in regard to extreme actions like physical violence. But environmental conditions genuinely provoke or inhibit behaviors and there’s no place where people are more reactive to environmental cues than in a psychiatric unit -because that’s where people with behavioral disorders are concentrated. All people respond to phenomena, but people who have poor frontal lobe function (nearly ubiquitous in mental illness) are far more susceptible than others. In the 1980’s a neuropsychiatrist, Francois Lhermitte conducted a series of experiments and defined three very similar disorders –‘utilization behavior’, ‘imitation behavior’ and ‘environmental dependency syndrome.’All
of these involve exaggerated dependencies on external cues to trigger action: utilization behavior is where people can’t inhibit the
desire to touch, play and use objects; imitation behaviour is when people can’t resist imitating someone else’s actions; and environmental dependency syndrome is a condition where people lack autonomy to behave other than as the space they’re in suggests that they should; they’ll buy things they don’t want or need if they’re in a store, they’ll hop into a bed when led into a bedroom (even if there’s no suggestion that the bed is theirs) etc. All of these disorders are caused by suboptimal frontal lobe function, suggesting that the inhibitory function of the frontal lobe is essential for allowing autonomous, independent or creative action. It also means that phenomena always exerts a force: it triggers conditioned behaviour, although with the caveat that it’s healthy to resist this effect (for adults at least). Further research by Golembiewski found that in healthy conditions, resistance to desirable actions and feelings is low. He also found that inhibition is nearly absolute in the face of negative imagery. In psychiatric conditions, he discovered this pattern is nearly reversed (resistance to negativity is very poor, and positivity about half) and in the light of this understanding, the psychiatrist’s observation that the corner itself provoked violence was highly astute. People enjoy ‘letting go;’ they like to abandon their inhibition when it’s safe to do so – but not everyone can. A sense of responsibility (one of many inhibitory functions) grows as people age, and sometimes the challenge to ‘let go’ becomes unsurmountable. The experience of riding a rollercoaster is something like terror if you’re worried about the safety engineering; and you can’t enjoy pogo dancing at a punkrock concert if you think someone might take out your eye, stomp on your toes, give you a disease or pull a knife. The threshold between a thrill and panic is therefore very fine, and
very subjective. Yet we can still make fairly accurate deterministic assessments while designing experience. Age and vulnerability all increase inhibition, as does a prior commitment: if at some point you’ve decided you’re frightened of spiders, that fear can be
very hard to shake. Being among happy-go lucky people decreases inhibition, as does laughter, some drugs, alcohol, and more than
anything, the confidence that everything’s going to be okay. An interesting thing about phenomena design is that the very same percept can cause vastly different experiences, depending on the greater, composite milieu. Most objects are relatively neutral, but we tend to ignore them, or experience them in the same light as the prevalent phenomena. Thus something like a sharp new cooking knife may trigger positive responses in a brightly lit store (“oh, what a lovely knife”), but the same instrument, on the ground in a dark alley out the back would be ominous. Our brains pick up the pieces to create a story, and in one way or another we always inhabit a narrative – or two. Just this year, Le Hunte and Golembiewski published an article on how the limbic areas of the brain compose and processes competing storylines. The organs within the limbic area are duplicated, allowing for multiple – potentially competing narratives to be maintained simultaneously. Each side has its own amygdala, which is thought to mediate ipseity; (a sense of how much the story is about ‘me’). The amygdalae are set into coil-like organs called hippocampi. These are thought to manage neural resources (language, memory, feelings etc.) into a story structure: a setup, event and consequences. Interestingly the limbic areas are situated between the frontal cortex and the striatum, meaning it’s efficiently positioned to serve either side with ‘context’. What’s also interesting is that humans have a massive gap dividing their limbic regions, suggesting that our ability to handle dual storylines is an anatomical feature. We can experience terror on one side of our brain, and confident comfort at the same time. For example we can simultaneously immerse ourselves in a DVD of Dracula, while sitting in bed with the absolute confidence that in ‘reality’ the greatest risk is of falling asleep without brushing your teeth. If an experience designer wants to increase the ‘entertainment factor’ of their work, they may think about how the duality which is so neatly embodied in the limbic system can be stretched. This can be done with a whole host of emotions – but stretching means increasing the dissonance between one side and the other: get people comfortable only to experience uncomfortable stories; make them feel safe, then send them off at 100km/h around a high and dangerous looking track in a small wobbly vehicle. The semiotics of experience design is like any other language; they’re learned throughout one’s life. But they’re also are far more universal. Before inhibition kicks in, the language of a cliff universally says “jump”. And you’d be hard pressed to find a place where a glass of water doesn’t say “drink”. The language of ‘affordance,’ as it’s called in psychology, is closely related to verbal language and can be even experienced as such, giving rise to ‘voices,’ the most common type of hallucinations in conditions where
frontal function is suboptimal. Leaving aside the psychiatrist’s solution, let’s imagine the task of redesigning a corner of a psychiatric unit that’s known as a hot-spot for violence. Here’s how I’d start: many psychiatric patients (if not all) suffer from reduced frontal function, meaning environmental affordances will have an uncannily powerful effect. I know that inhibition is likely to decrease this effect, so an important first step will be construct a story that instructs users to ‘button-up’. The language to convey this message is also important. I know that negative and mean language will trigger unwanted behaviour and that positive and desirable phenomena will trigger desirable behaviour – smiles, laughter, constructive thoughts and good feelings.
I also know that in psychiatric conditions the effect of positive language is reduced (relative to declaratively healthy people), whereas the effect of negative language will be much worse. I manage the negative language of the environment by auditing and removing anything that speaks of meanness, oppression, inequality, ugliness or suchlike. I then try to imbed positive affordances into the environment: light-feeling art, happy music, pleasant lighting, views into gardens and nice smells – perhaps from soft breezes, carrying in the aroma of flowers from a garden. The story is expressed as a typology: a whole picture that’s recognisable and is associated
with desirable behavioural cues: A foyer of quality hotel would be ideal. When you enter the Ritz or the Plaza the milieu instructs you to dust up your appearance, to communicate politely and otherwise be more inhibited than you would be outside on Piccadilly or Central Park, yet it also speaks with a very positive language: fresh flowers, an immaculate aesthetic, smiling and helpful staff and the
general picture of quality brings out the best in behaviour. There’s no doubt that a healthy person can behave as they please in any environment, but the pressure to behave as instructed increases as mental illness takes hold. The result is that a dust up in the Ritz is difficult to predict – because, to a great extent it’ll be motivated by very personal experiences and choices, and as such, it’ll be impossible to design-out (without closing the bar). But in a psychiatric unit, patients can’t be blamed– a fact already enshrined in many legal precedents. If there’s violence in a psychiatric unit, the best place to point fingers is toward the walls, the furniture and staff attitudes, because whether those responsible knew it or not, they somehow were responsible for brewing an “Attack Me” potion.
In Lewis Carroll’s hallucinatory tale, ‘Alice in Wonderland,’ there’s a bottle that ‘says’ to Alice, “Drink Me.” There’s also a piece of cake that has “Eat Me” inscribed on it in currants. This suggests that Carroll was aware of the language of affordance. Dr. Jan Golembiewski is the Knowledge and Research Director at Medical Architecture Australasia Pacific (Australia) and an Adjunct Professor at Queensland University of Technology. Golembiewski is one of the world’s leading researchers in healthcare design innovation, with a particular interest in the human aspects– in architectural design psychology and the sociological aspects of procurement. His PhD studied the neurological and endocranial systems that mediate experience and how these biological systems are affected by experience. This is especially relevant in healthcare architecture, because aesthetic, social and functional aspects of the environment genuinely affect health and wellbeing; where this influence isn’t directly causal, it still affects recovery.


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