The Boston Government Service Center (BGSC) looks like the last place one would want to go for help. Designed by Paul Rudolph immediately after he completed the Art and Architecture Building at Yale in 1963, the BGSC incorporates all of that earlier building's cave-dwelling mystery and brave experimentation with the abrasive qualities of concrete. But it was designed on a much grander scale--the BGSC occupies a superblock on the lowest slope of Beacon Hill, consolidated in what might be the nation's most infamous act of postwar urban renewal, the destruction of Boston's West End--and with more harrowing possibilities for unhinging the minds of those unfortunates inside.
The Art and Architecture Building has often been singled out as an example of unnecessarily belabored and disorienting space; in the catalogue for an exhibition to celebrate its opening, Vincent Scully famously warned that the building "puts demands upon the individual user that not every psyche will be able to meet." In the BGSC, and particularly the Lindemann Mental Health Center, which shares the spiraling megastructure with several civic bureaucracies, Rudolph would expand on Art and Architecture's dark palette of labyrinthian spaces, and the result in human terms would be infinitely worse.
Erich Lindemann, for whom the center was named, was a respected Boston psychiatrist and a professor at Harvard in the 1960s. There is considerable irony in his being honored with this dedication. Among his then-recent works was a well-publicized study that recorded the deleterious side effects of urban renewal, focusing on the experiences of residents in the West End. He would later help lead a movement that brought psychiatrists, designers, and urbanists together to study the influence of man-made environments on mental health. The building that still bears his name would go on to be a notorious example of architecture's power to confuse, agitate, and sometimes fatally overwhelm.
In a 1993 lecture, Rudolph joked that he could finally admit that the "wasted space" of any building is "more important than that which is used," because it provides "space for the subconscious." This remark echoed one he had made in an interview 20 years earlier: "The relationship between everyday needs and spiritual needs is very complex, and they are often at war with each other. Mere Functionalism is never enough." In the same interview, Rudolph indicted the International Style for ignoring what he called the "psychology of space." At the center of this only vaguely elaborated theory is the recurrent idea that buildings should enrich the public and embody their aspirations. Rudolph reasoned that "there [are] certain types of buildings that need to rise above Functionalism," and these buildings should "move people." In the BGSC--a building of this type--an expression of the building's program should therefore supersede its use. The Lindemann Center became a tragic experiment in the antagonism of function and the "psychology of space."
Reveling in his newfound expressive freedom, and armed with his theory of psychology, Rudolph chose to sacrifice the function of the Lindemann Center to further an emotive agenda. The essential aim was to express the program of the building, while creating within an environment "suitable" for the mentally ill. Thus, the spaces inside reflect Rudolph's romanticized view of mental illness: eerie, twisting stairways, one of which leads nowhere like an oubliette in a Medieval keep; amorphous passages that never reveal their ends; a chapel that creates a stirring, dismal ambiance through spatial theatrics. On the exterior this atmosphere is communicated through an unwitting architecture parlante--not a symbolic program but a concoction of private motifs--intended to perpetuate the mood at a subconscious level. In short, Rudolph made the building "insane" in order to express the insanity within.
Rudolph's dramatic spaces and subliminal imagery (there's a thinly veiled frog's head looking out from the building's facade) make the Lindemann Center very expressive, and very dangerous. As has been noted by psychiatrists who have worked in the building or sent patients there, the building can be physically and psychologically damaging. Indeed, it is not hard to imagine the effects of the building's subtle, encrypted psychedelia on a patient already prone to paranoia and hallucinations. In his book Treating the Poor (1992), Matthew Dumont, a Boston psychiatrist, records his apprehensions about sending a schizophrenic patient to the Lindemann Center. "There is a certain perverse genius in the design of the building for people with poor ego boundaries," Dumont writes. He argues that elements of the building actually conspire to defeat mentally ill patients' efforts to orient themselves in space. One culprit is the bush-hammered concrete, used, as at the Art and Architecture Building, on every surface, inside and out. Dumont writes that patients "generally like to tap a corridor wall as they walk down it as a way of assuring themselves that they are not falling through a dreamlike vortex. But if you try to touch the wall of a corridor at Lindemann as you walk, your knuckles are likely to be bloodied." The exterior stairs also actively disorient patients by "majestically [rising] not to but through the building" and by inducing what one Lindemann staff member referred to as a "kinesthetic disorder." Dumont describes this phenomenon: "A Cinderella staircase emerges gradually from engraved curvilinear lines in the sidewalk. One stumbles at first, thinking that the lines represent steps, and then stumbles again when they imperceptibly do begin to become steps. With a short rise and a two-foot tread, they cannot be climbed one at a time: one has to take a short, limping, extra little step to reach the next one. The building thereby programs disabled behavior."
Responses to this environment are predictably tragic. Horror stories of patients lost in the building are common, as are accounts of assaults on patients and staff in its many dim, secluded alcoves. Indeed, the building has proved to be so insidious that it is possible to hold certain spaces responsible for repeatedly abetting self-destructive acts. A catwalk over the Lindemann's plaza-level lobby had to be glazed after it invited too many suicide attempts. The chapel, a top-lit chamber called out on the skyline with a crowning finial, is experienced as the heart of the building, what Rudolph once called "that releasing space which dominates." It has been sealed shut since shortly after the building opened in 1972; a patient died there after igniting himself on the concrete slab altar. As one former Lindemann Center psychiatrist noted darkly, the patient was just following environmental cues: "It looks like a place that should be used for human sacrifice."
The little-known tragedy at the Lindemann Center could supplant the firebombing of the Art and Architecture Building as an emblem of the confusion in Rudolph's work. But beyond Rudolph, the saga of the Lindemann is a sort of cautionary tale about Modern architecture's persistent belief that it can affect human behavior. As this extreme example shows, it can certainly hurt. Can architecture also heal?
In the wake of deinstitutionalization in the 1960s, and the new psychotropic drugs that made it possible, schizophrenia was the signature mental health issue at the time the Lindemann Center was built. With the number of Americans over 65 expected to double within the next 20 years, Alzheimer's disease is now the hot-button topic in the field. As many as three million Americans may currently suffer from some form of age-related dementia. Here, too, architects and design consultants are moving in with spatial remedies. Today, however, it is with humility, not hubris. In place of the arrogance that Rudolph exemplified, designers are approaching the problem with an eye to the limitations of architectural intervention. And they are sharing information with the people who know the most: doctors and the patients themselves.
In 1988, Margaret P. Calkins published Design for Dementia: Planning Environments for the Elderly and the Confused, the first book for architects attempting to mitigate the effects of Alzheimer's--and one of the first to take into account the experience of medical experts. The book gave advice on planning, including ways to control wandering in this notoriously mobile population, and sketched out what would become the core of a new subspecialty in architecture. Calkins now heads IDEAS Inc.--it stands for Innovative Designs in Environments for an Aging Society--a consultancy based in Kirtland, Ohio. Her principal product, REMODEL, is also a sprawling acronym: "Resource for Evaluation and Modifications Optimizing Dementia Environments for Living." Through this service, Calkins' group evaluates Alzheimer's clinics and recommends custom solutions at three levels: "minimizing disruptive behaviors" (wandering, rummaging, hoarding); "maximizing cognitive and functional abilities" (orientation, continence, bathing); and "enhancing self and sense of home" (privacy, personalization, roles, and activities). Her solutions often focus on helping residents to identify their own rooms. In almost every one of the 60-plus REMODEL consultations she has provided, she suggests that flat signage be replaced with a vitrine displaying personal effects that remind the resident of home.
The idea of "home" is central to the new Alzheimer's architecture. Patients, it is believed, will be happier in a noninstitutional environment, and, as Calkins says, "No one wants to deal with an unhappy person with dementia. It's not a pretty sight." One common way to increase hominess in an existing ward is to remove the fortress of the nurses' station. The key, Calkins says, is to keep the nurses away from it: "As long as they have it, they'll hide behind it." At the Hennis Care Center in Dover, Ohio, the management was so eager to adopt this new idea that they ripped out the nurses' station without a next move in mind; the nurses went off to lunch and they came back to find it gone. A period of limbo ensued, during which Calkins was eventually contacted. With her help, Hennis found a local Amish carpenter who supplied an unintimidating lift-top desk that Calkins described as "a country kitchen table."
Calkins, who has a master's degree in architecture, researched Design for Dementia as a graduate student at the University of Wisconsin at Milwaukee, where she was the first research fellow at the school's Institute on Aging and Environment (IAE). Her professors Uriel Cohen and Gerald Weisman subsequently became interested in the possibilities of designing for dementia, and they have since started a consultancy that competes with Calkins' IDEAS. Their National Alzheimer's Design Assistance Project convenes regularly to assess progress in the field.
David Hoglund, an architect at the Pittsburgh office of Perkins Eastman Architects, is a member of this group. He has designed more than 35 treatment centers throughout the United States and Canada. His best-known design was his first, for Woodside Place, a 36-bed Alzheimer's facility in Oakmont, Pennsylvania, completed in 1991. Woodside Place pioneered the implementation of the "home" model, where wards are broken up into smaller "houses," and residents typically share a "living room" and sometimes responsibilities for cooking and cleaning. The decor is emphatically noninstitutional; it tends to heavy pine furniture, quilts, and a representative sampling of the tchotchkes that accumulate as one lives for some time in one place. Woodside Place and other Hoglund projects have won numerous awards and been studied extensively by researchers in the field. Scientific results--generally based on changes in mortality rates--are inconclusive. Is the architecture helping? Does it heal? David Hoglund is circumspect on this issue. "'Heal' may not be exactly the word. In some cases we can stabilize patients' decline."
Hoglund's second project, Copper Ridge, in Sykesville, Maryland, begins to show some of the shortcomings of assuming that home equals comfort equals life. Soon after it opened in 1994, Hoglund says, "one patient sat in the 'country kitchen' and asked to be paid if she was going to have to work serving meals." That patient might be better served in what Margaret Calkins has identified as the "resort" model of Alzheimer's care. "I don't think that 'home' is the only model. It's not like you have a continuity with 'institution' at one end and 'home' at the other," she says. Calkins' research has identified the importance of matching patients to a particular setting. Some like home, some appear to be happier in an institutionalized setting, and some respond best to an environment that models itself after a resort: heavy on activities, nurses trained to act almost like cruise-ship staff. "There are people who would not be comfortable in an environment that is too casual, people who would know they are in a hospital and would wonder why it didn't look that way."
With this caveat, Calkins supports the home model. As an example of an ideal project, she cites Hearten House III, in Holmen, Wisconsin, completed by Wisconsin architects Kratt Associates in 1993: "It is very successful at being what 'home' is. It looks like a house and acts like one." Still, she stresses that architectural intervention must be matched by specific changes in staff training: "There are a dozen different ways to serve a meal." Calkins has also done research that seems to prove the effectiveness of "home" for certain people. At the Evergreen Retirement Community in Oshkosh, Wisconsin, a new home-style unit called Creekview was constructed in 1996. Designed by the Minneapolis-based Nelson-Tremain Partnership, it is adjacent to similar-size units that follow the traditional, institutional treatment model (in other words, they look like a hospital and act like a hospital). In this instance, Calkins, says, all variables except the environment could be canceled out. The results, after several years of operation, showed that the institutional clinic had a 32 percent mortality rate versus 20 percent for the new family-style space next door. In Oshkosh, at least, it appears that architecture is helping to prolong life.
In their low-key way, Calkins and Hoglund are exploring the same ground--between "everyday needs" and "spiritual needs"--that so fascinated Rudolph and that got him into so much trouble in the Lindemann Center. The difference may lie in architectural heredity. Rudolph, like many of the architects of his generation, was rebelling full force against Modernist strictures, formal and intellectual. It was form first, inhabitants be damned. Though the aesthetic means could not be more different, DNA evidence would reveal that Calkins' and Hoglund's projects are the kin of the touchstones of Modern architecture from the 1920s--Corbusier's cleansing white workers' housing at Pessac, the white blocks of the Weissenhof Seidlung in Stuttgart--buildings that sought to improve society through form. Even Gropius's Dessau Bauhaus was intended as an architectural machine for transforming behavior--the behavior that resulted in non-Modern buildings.
That shining belief in architecture's ability to positively affect its denizens--usually thought to have died with the destruction of Minoru Yamasaki's Pruitt-Igoe housing in St. Louis--survives, at least in the minds of some architects. But outside the profession, voices are considerably more restrained. Barry Lebowitz, a specialist in dementia-related issues at the National Institute of Mental Health, seems doubtful that architecture in any form can make a difference in the treatment of Alzheimer's disease: "Maybe design can relieve symptoms a little, while medicine works to keep brain cells from dying."
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