Washington Monthly - September/October 2020 - 110

reach them and the lower their odds of survival," Anthes concludes. It's fair to wonder,
however, whether there's another explanation for patient survival rates. Curious
sleuths can check the exhaustive notes at
the end of the book to reference the original studies (this one is from the Canadian
Medical Association Journal), but in general,
the reader must trust Anthes, a respected
writer whose previous book, Frankenstein's
Cat, won several science journalism prizes.

he first imperative of most indoor environments, almost by definition, is to
shield its occupants from what's outside.
(Partial exceptions include greenhouses
and tanning salons.) A roof that lets in the
rain, or a tent that lets in the bugs, isn't doing its job. A key theme of Anthes's book,
however, is the degree to which the inverse
phenomenon is also true: Dwellings that

levels, and immune activity. Some hospitals are now experimenting with artificial indoor "circadian lighting" that varies
throughout the day, from morning blues to
golden afternoons.
Greenery is also important. A pioneering study published in Science magazine in
1984 compared the medical records of patients who had their gallbladders removed
at a Pennsylvania hospital between 1972
and 1981. Half had window views of a forest; half stared through windows at adjacent building walls. The former group
requested fewer painkillers and were discharged from the hospital a day sooner.
Many subsequent studies have linked time
spent outdoors or in plant-filled rooms
to higher test scores and better overall
health-although, unlike the gallbladder
study, these tests generally can't rule out
the potential impact of other factors. (Perhaps wealthy people, for
example, who have better health outcomes for all
sorts of reasons, also happen to have more access to
green space.)
How exactly nature
heals remains a matter
of debate. Anthes speaks
to two well-known psychologists at the University of Michigan, who tell
her, as she paraphrases it,
that "natural settings give
the brain a break from
the cognitively exhausting tasks-from
memo writing to meal planning-that fill
our daily lives. Nature draws our attention but engenders an effortless kind of
engagement, often called soft fascination,
that allows the mind to rest."
American prisons are rarely designed to
put people at ease. That's why Anthes visits the Las Colinas Detention and Reentry
Facility, a women's prison in Santee, California, which incorporated new thinking
about psychology and design into a facility upgrade in 2014. As one researcher tells
her, "One of the things that the physical
environment does, that humans respond
to, is that it gives you a set of expectations
about how people are likely to behave and
how people think you're going to behave-
what we expect from you."

One point of consensus: Open
offices were a terrible idea, even
before COVID-19 arrived.
They don't facilitate productive
brainstorming, and no one does
their best work surrounded by
germs and background chatter.
remove us too far from the natural world
can be just as harmful as ones that don't
protect us enough.
Take sunlight. Patients in hospital rooms
without windows use more painkillers, report more stress, are discharged later, and
have higher mortality rates than those in
sunny rooms, according to several studies.
"Though it's difficult to pinpoint the precise mechanism, sunlight can reduce blood
pressure, enhance mood, boost vitamin D
production, and, we now know, kill pathogens," Anthes writes. Natural light variation during the day is also significant. Scientists believe the short-wavelength light
of morning, which looks cool and bluish
to us, is most vital for controlling our circadian rhythms, regulating daily changes
in respiration, blood pressure, hormone
110 September/October 2020

The architects overseeing the redesign of
the women's prison decided, as Anthes put
it, "that correctional facilities should look
less like impersonal institutions and more
like actual homes." That meant replacing
steel toilets, concrete benches, and metal tables bolted to the ground-built with
the expectation of malicious damage-
with wood furniture, much of it painted
sea-foam green. Common areas included
large windows and cityscape murals, rather than blank gray walls.
Most significantly, the guard station
was situated at an open desk in a central
dayroom, a design called "direct supervision." "The more contact that staff had directly with the inmates, counterintuitively
to some people, the safer everybody actually was," one researcher told Anthes. "If
the staff and the inmates were actually interacting, they started treating each
other more like people instead of objects."
Assaults on staff dropped by half in the refurbished facility.

f there's one thing I wanted more of from
the book, it was a clearer view of which
of these design tweaks might scale up from
a quirky idea to broad reality. Will circadian lighting become mainstream for hospitals soon, and will open offices be relegated
to the dustbin of history? Will more prisons reinforce the idea of rehabilitation over
punishment in their designs? These questions don't have purely scientific answers.
Even good ideas need money and political
backing. But that's where books like this
can help, especially if they find an audience
among policymakers or entrepreneurs
keen to imagine new spaces. It wouldn't be
the first time such ideas found resonance;
mid-19th-century reformers in New York
called for reimagining tenement housing,
and their efforts brought about modern
sanitation services.
Meanwhile, it's a delight to daydream,
especially as we hunker down in the middle of a pandemic. While we wait for the
wider world to reopen, we might as well
think about what will need to be reshaped,
and what can be left behind for good.
Christina Larson, a former Washington Monthly
editor, is an award-winning science journalist
who has reported from five continents.

Washington Monthly - September/October 2020

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