Through a close reading of a single photograph from the 1980s, architectural historian Megan Brien demonstrates how the spatial dynamics and design features of a hospital ward shaped patient identities and behaviour.
As Adrian Forty states ‘design can cast ideas about who we are and how we should behave into […] tangible forms’.[1] A single photograph of a renovated long-stay ward in St Ita’s Hospital, Dublin, dated 1985, supports this statement and gives a literal snapshot into the provision of past residential mental health care. Without supporting evidence of architectural plans, medical reports, first-hand accounts, or other primary sources, what can this single photograph tell us about the people who lived in this ward, and how they behaved?
As a historian researching the interior of psychiatric hospitals, I’m interested in exploring how ephemeral and often intangible interiors of the past can inform our understanding of patients’ lived experience. By taking a design historical approach, a detailed reading of St Ita’s ward provides an opportunity to demonstrate how interiors, through placement and arrangement of decorative objects and furniture, created meaning, shaped identity and influenced behaviour.
Form and Function
The first thing we might notice is that thirteen bed frames surround the edges of this photograph. The lack of any other furniture implies this ward had a fixed mono-functional purpose: to provide shared dormitory space for hospital patients. The position of each bed was along the length of the ward, following the design principles of the open ward plan.[2] The formal structuring and equidistant placement of each of the bed frames physically and visually constructed a long thin corridor of open space through the centre of the room, using a ‘perimeter configuration’.[3] This spatial orientation appears to have served a simple function, providing a clear pathway of circulation through the ward for nurses, doctors, and patients.
Closer examination at the section of flooring located at the centre of the photograph reveals the permanency of this arrangement. The lacquer on the herringbone patterned wood floor has worn away, evidencing years of repetitive use despite the fact that each bed’s castor wheels allowed for the free movement of the bed frames within the ward.
A singular chair nestled between the two bed frames at the front left of the photograph interrupts the static and linear layout. The lack of additional bedside chairs or alternative seating arrangements in this dormitory ward implies that only one patient could sit at any one time. The remaining patients could walk through the ward or remain stationary within the confines of their designated bed.
The photograph implies that the patients of this dormitory were not only organised and restricted by the presence of furniture, but also impacted by the absence of additional furniture items within this spatial configuration. The use of a methodical and linear orientation in the dormitory exemplifies what Michel Foucault described as a disciplinary system of patient regulation, within which the patient would ‘[…] be observed, surveyed, known and cured.”[4] The dormitory spatial arrangement primarily benefited the observer from their position of power through a structure that supported the workflow of staff members and increased opportunities for patient surveillance.
Experience
The positive attributes that the spatial layout provided for staff members did not equally transfer to the patient experience. Detailed analysis of this photograph emphasises how narrow the clearance space between each bed frame was, where a sliver of the accessible floor served as a walkway and a boundary between neighbouring patients. A similarly limited amount of floor space served as a perimeter across the ward between the foot of each bed. A patient’s personal space within this ward remained confined to the boundaries of their bed. Beyond the boundaries of a patient’s bed, the no man’s land of unclaimed space in the middle of the ward was shared, an open and communal space. These spatial dynamics limited the privacy of each patient, impeding opportunities for personal space, seclusion, and comfort.
Initial analysis of the positioning of the bed frames infers that the interior environment was uniform, yet a closer look reveals additional and distinct design elements in the furnishing of the ward. The bed frames on the left side of the photograph are off-white enamelled metal with an adjustable headboard. On the right, the beds are a different design, a fixed frame model finished in a brown enamelled metal with a rectangular veneer headboard and footboard. The inclusion of two different designs within a singular ward exemplifies a point of disparate patient experience. Patients on the left side could adjust and reposition the upper quadrant of their bed, thus had a small modicum of control of their immediate surroundings. In contrast, patients on the right side of the dormitory did not have this option.
The spatial organisation of the dormitory beds produced additional opportunities for diverging patient experiences. On the left side of the ward, the beds faced four window openings, three large scale panelled windows and a fourth smaller window positioned above the emergency exit in the right corner of the dormitory. From an observer’s perspective, the large windows benefited the dormitory, allowing an abundance of natural light and ventilation into the ward. That said, patients of open wards did not welcome the bright intrusive light that the large windows provided. By facing these windows, patients would often be uncomfortable, facing the sharp glare of the sun.[5]
On the right side of the ward, three radiators sat beneath each of the larger windows, located between the boundary wall and the bed frames. Patients positioned on the beds directly in front of these radiators had no control over the temperature of their immediate surroundings and were likely to experience extremes in temperature from the heat radiating against the headboards and the cold air seeping through the single-paned windows. Both sides of the ward faced environmental factors which negatively impacted the patient experience in different ways; factors which the spatial layout of the dormitory exacerbated.
Domestic
In their Architecture and the Modern Hospital, Julie Willis, Philip Goad and Cameron Logan emphasise that ‘homeliness was a measure of psychological comfort [in the hospital], intended to reassure the patient that they had not been institutionalised’.[6] The interior of the dormitory ward at St Ita’s similarly aimed to replicate the domestic environment in an effort to diminish the medical atmosphere of the congregated setting.
Decorative soft furnishing in the ward took the form of bedspreads, which helped mitigate the sanitary and utilitarian frame of the hospital bed. The baroque pattern with fringed edging that covered each of the beds appeared frequently in domestic bedroom décor in the period. Alongside the bedspreads, elements of decoration such as the chintz floral curtains that framed alternating windows, and the artworks positioned between each window, aimed to further cultivate a domestic environment within the psychiatric hospital ward.
Unlike a true domestic environment, however, the furnishing of this dormitory did not make provision for patients to display or store personal belongings. The absence of bedside lockers or alternative storage facilities is acutely apparent in this photograph. The interior furnishing of the ward limited opportunity for patients to express individuality or a sense of self within their immediate surroundings.
Additionally, the inclusion of conventional and unavoidable forms of furnishing for medicalised spaces such as hospital beds, emergency exit signs and fluorescent strip lighting, instilled an impersonal quality to the dormitory ward, undercutting attempts to make these spaces appear homey. These regulatory features visually reinforced the fact that the ward was a shared and regimentally structured clinical environment. As captured in this photograph, the decorative elements and inclusion of soft furnishings never quite achieved the domestic environment that the hospital ward aimed to cultivate.
Design historian Penny Sparke maintains that individuals ‘form their own identities in response to the spaces in which they have found themselves’.[7] Critically, the label of ‘patient’ was spatially and visually reinforced onto the persons who resided in the ward through the design of the dormitory interior. Accepted behaviour standards were embedded into the spatial arrangement of the ward, which divided the observer from the observed, staff from patient. As patient experiences are individual and relative to their immediate surroundings, this close reading concentrates on the frame of the photograph rather than what is omitted. This method allows for careful consideration of patients’ lived experiences in a defined spatial and material environment, providing a partial perspective from a single ward of a vast institution.
Megan Brien is a Government of Ireland Postgraduate Scholar, working in the Department of History of Art and Architecture atTrinity College Dublin. She tweets at @Megan_Brien and can be reached via email on mbrien@tcd.ie.
Bibliography
Forty, Adrian. Objects of Desire: Design and Society, 1750-1980. London: Thames and Hudson, 1986.
Foucault, Michel. “The Incorporation of the Hospital into Modern Technology.” in Space, Knowledge and Power Foucault and Geography, edited by Jeremy W. Crampton and Stuart Elden, 151. Hampshire, England: Ashgate Publishing, 2007.
James, W. Paul, and William Tatton-Brown. Hospitals Design and Development. London: Architectural Press Ltd, 1986.
Johnstone, Fiona. “Manifesto for a Visual Medical Humanities,” Medical Humanities, July 2018, https://blogs.bmj.com/medical-humanities/2018/07/31/manifesto-for-a-visual-medical-humanities
Sloane, David Charles, and Beverlie Conant Sloane. Medicine Moves to the Mall. Baltimore: Johns Hopkins University Press, 2003.
Sparke, Penny. “Introduction.” in Interior Design and Identity, edited by Susie McKellar and Penny Sparke, 3. Manchester: Manchester University Press, 2004.
Willis, Julie, Philip Goad, and Cameron Logan. Architecture and the Modern Hospital Nosokomeion to Hygeia. United Kingdom: Routledge, 2019.
References
[1] Adrian Forty, Objects of Desire: Design and Society, 1750-1980. (London: Thames and Hudson, 1986), 6.
[2] W. Paul James and William Tatton-Brown, Hospitals Design and Development (London: Architectural Press Ltd, 1986), 75-79.
[3] David Charles Sloane and Beverlie Conant Sloane, Medicine Moves to the Mall (Baltimore: Johns Hopkins University Press, 2003), 45.
[4] Michel Foucault, “The Incorporation of the Hospital into Modern Technology,” in Space, Knowledge and Power Foucault and Geography, ed. Jeremy W. Crampton and Stuart Elden (Hampshire, England: Ashgate Publishing, 2007), 151.
[5] Julie Willis, Philip Goad, and Cameron Logan, Architecture and the Modern Hospital Nosokomeion to Hygeia (United Kingdom: Routledge, 2019), 45.
[6] Willis, Goad, and Logan, Architecture and the Modern Hospital Nosokomeion to Hygeia, 25- 27.
[7] Penny Sparke, “Introduction,” in Interior Design and Identity, ed. Susie McKellar and Penny Sparke (Manchester: Manchester University Press, 2004), 3.
