Anthropologist Steven Feld notes: ‘as place is sensed, senses are placed; as places make senses, senses make place’.[i] The hospital is indeed made by its sensescapes, and these are more than just a sum of their parts. In order to understand how the ‘senses make place’ in the hospital, we need to think more about what the senses mean in this context…
The senses in hospitals
Between the senses
‘What are the senses?’ seems one of the easiest possible questions to answer, but even this is not as clear-cut as it seems. Some excellent scholarly work exists on the five classic senses, including their embodied and cultural dimensions, and on specific sensations such as pain, but we lack much (historical) work on how these all work together. Intersensoriality is one aspect of this question: patients’ narratives indicate that senses overlap and interact in the hospital, making it impossible to separate them out neatly. There are also senses that seemingly ‘fall down the gap’ if we keep to classifications that are too clear-cut: in the waiting room, is time a sensory experience, and if so which of the ‘five senses’ is it? In a scanner, is claustrophobia a form of sensation? There are many aspects of hospital sensescapes that don’t fit into traditional five-sense models. Some neurologists suggest that we have up to 21 senses, but perhaps neurology is not the best place to start with a sensory history of hospitals.
If we work through the hospital in terms of spaces, rather than senses, what different conclusions might be reached? In the light of this question, it is perhaps a mistake that this project blog even includes the traditional breakdown of five senses at all. However, it is still worth thinking through how the hospital relates to some of the excellent existing work in this area. In particular, there are some interesting discussions around questions of active / passive senses (can you ‘close your ears?’), about the relationship between these senses and modernity (is the modern age a ‘visual’ one?), and about the need for more historiography on some senses (does the greater prevalence of historiography on hearing than on tasting reflect our own cultural preoccupations?): these are crucial to acknowledge and engage with in relation to space and the hospital, before we probe further into other forms of sensory experience and intersensoriality.
The traditional story of modern medicine is often one of the decline of the senses. The rise of diagnostic technologies, we are told, has led to the rise of the medical ‘gaze’ and the decline of sensorial diagnosis such as the use of touch or smell. David Howes and Constance Classen’s Ways of Sensing makes similar comments about the contemporary hospital, observing that it ‘is a decidedly unaesthetic place’.[ii] There is some basis to this kind of narrative. Hospital design in the late twentieth century focused on removing sensory nuisances, such as smell and noise, and increasing patient privacy. The hospital sensescape has undoubtedly also changed over time, and in some ways the removal of sensory nuisance has aligned with ‘unaesthetic’ design: cleaner, quieter… but is sensory absence in itself an aesthetic experience? Does silence truly exist in the hospital, or is it only a relative experience? Does eliminating ‘noise’ eliminate ‘sound’? Does the removal of the famous ‘hospital smell’ really leave a smell-less environment, or rather open it up for other more subtle smellscapes? Does the removal of ‘sensory overload’ and external stimuli make a sense-less hospital, or does it turn the sensory gaze inward?
The issue of sensory absence draws attention to the issue of different sensory abilities and needs. Many people experience the absence of certain senses as part of their embodied experience of the world, rather than in consequence of specific design choices in the modern hospital. Memoirs, such as John Hull’s recently reprinted Notes on Blindness, engage articulately with the implications of the absence of one sense for engagement with other sensory experiences. On the other end of the spectrum, there are neurodiverse patients who have heightened sensory awareness and may quickly experience sensory overload in busy hospital environments. Patients, staff and visitors have a whole range of individual sensory needs including more moderate forms of sensory impairment, or heightened sensory awareness, that affect their embodied experience of the sensescape. As a microcosm of society, the hospital inevitably includes people with extensive differences in their sensory perception. It is important to remember that the hospital sensescape ‘feels’ different to them; their experiences have also changed over time with shifts in accessible design and technology.
Sensory difference is also not only about heightened or reduced senses. Sensory experiences might take on different meanings in line with life experiences and cultural background, as well as with age, gender and the nature of a person’s illness / recovery. In turn, time spent in hospital might change the associations (and feelings) associated with particular senses; it is not easy to separate the ‘objective’ sensory experience from the personal or perceived. Within hospitals, difference spaces also have different sensory characteristics: maternity spaces, for example, have long been designed with holistic and soothing multi-sensorial properties in mind; in contrast, the sensescape of high-technology intensive care is thought to contribute to ‘ICU psychosis’.
The extent of these differences – between different hospital spaces and the people in them – poses a challenge. If we add in differences across time and place, and seek to do justice to a ‘more than five’ sensory model, we are faced with a possibly overwhelming project. We need to find ways to organise and understand these different sensescapes, while doing service to them and their complexities.
[i] Feld, S. Waterfalls of Song: An acoustemology of place resounding in Bossavi, Papua New Guinea. In: Feld S, Basso KH. eds. Senses of Place. Santa Fe, NM: School of American Research Press, 1996: 91.
[ii] Howes D, Classen C. Ways of Sensing: Understanding the senses in society. Abingdon; Oxford: Routledge, 2013: 58.