Day Two

Day two kicked off with the panel Senses and Design to consider how architecture shapes clinical experience. Megan Brien’s paper ‘Reuse, Adaptation and Misalignment – long stay care facilities, in 1970s Ireland’ explored the relationship between planned and lived experience through 1970s psychiatric hospital architecture. The stylised renovation of the hospital used familiar domestic patterns and decorative furnishings, typical of the 1970s, to try and personalise these spaces. However, Brien noted this was only on a surface level and instead reinforced the impersonal shared spaces. This was evidenced in the living conditions: the homemaking of flowers and pictures hung in female wards, in contrast the male wards had no decorative artworks or curtains and were extremely utilitarian. Brien argued this signified the lack of medical and social progression within these spaces, even though the government at that time was moving towards more community care practices. The gendered disparities highlighted the difference and misalignment of lived experience within the same hospital. This had parallels to Sarah Campbell’s work in thinking about gendered atmosphere as a sensory composition of care environments.

The redesigning of clinical spaces in hospital architecture was expanded on by Benjamin Dalton in the presentation, ‘Sensing “the great outdoors” through hospital architecture: Redesigning clinical space as a site of affective discovery through Catherine Malabou and Arakawa and Gins’. This was underpinned by the idea of plastic transformable bodies, a philosophical theory of Catherine Malabou. This insisted on space as a site of radical encounter, therefore Dalton asked what if clinical spaces could embrace the disorienting and transformational aspect of healthcare. The avant-garde architects Arakawa and Gins’ ‘Healing Fun House’ proposed architecture itself as healing through radical and emancipatory design. The buildings insisted on keeping people within a state of imbalance, so the body was always feeling its way around the architecture and remained in constant dialogue, and kept people in a state of otherness or strangeness. By emphasising space as ‘radical exteriority’, as opposed to familiar interiority, how might this prompt experiences of metamorphosis or change in the clinical setting.

dalton-talk

Zoe Schoenherr, whose background is in environmental psychology, related design of the hospital setting to neonatal care units. Schoenherr’s talk ‘An Evaluation of the Family Integrated Care Model and the Design of Neonatal Wards’. It considered how its design could be redeveloped to improve care provided to infants, reduce the number of transfers of vulnerable babies to other hospitals, parent and infant separations, and to improve the continuity of care. By adopting a Family Integrated Care Model, Schoenherr argued that the hierarchy between clinical staff and parents was broken down, both were viewed as experts in shared decision-making. To have parents contribute to the ward environment and to the care of the babies has proven to reduce levels of stress, infection, lengths of stay on the ward, and improve levels of bonding, baby growth and development. Therefore, Schoenherr’s study wanted to understand how to improve the design of the Neonatal Intensive Care Unit and has developed a framework to be implemented as part of a neonatal hospital in the Northeast of England.

The next panel Institutional Experiences began with Verusca Calabria’s paper ‘“It was a nice atmosphere; we were all like a big family”: relational institutional landscapes’. This focused on the role of non-medical staff and their informal care practices within mental health institutions in the last half of the twentieth century. Experiences of patients in care institutions remain underexplored, and the nurses and nonmedical staff continue to be marginalised. Consequently, Calabria used interviews with previous patients and long-serving non-medical staff to consider the role of the senses in relational care practices. Calabria noted how this acts as a lens to interpret embodied experience and study the role of the sensescapes for non-medical staff narratives. This allowed us to access the form of care they gave, which in turn gave agency back to these individuals who have been previously forgotten.

Anna Jamieson expanded on the role of the senses within institutional settings by delivering a paper on ‘Touch, Care and Connecting with the Eighteenth-Century Madhouse’. This discussed the final decades of the eighteen century and the ‘private madhouse’, noting the importance of recognising the senses to give a better understanding of lived experiences. This paper was informed by archival and historical work, drawing on uncertain and speculative encounters to provide windows of insight. Like many of the other panels, Jamieson drew on Roy Porter’s call for patient-focused scholarship through material history, and in doing so recalibrated our understanding of objects relating to women, psychiatry, and private care. Our conduit into this world is a woman called Dorothea Fellowes, the focus of this work. By investigating piles of receipts, Jamieson was able to recreate Dorothea’s material world to build a sensescape of the madhouse. Through a sensorial underpinning of object history, Jamieson questioned the positioning of women as ‘powerless objects’ within systems of patriarchy.

We then moved to the Emotions and Objects panel, commencing with Roxana Girju’s paper: ‘A Multimodal Empathic AI Interface for Telemedicine: The Next Level in Patient-Provider Experience’. The sensory capability of Artificial Intelligence today refers to computer vision, hearing through voice recognition, touch through gestural interfaces, smell through digital olfaction, and digital taste. Whilst there has been significant advancement with AI, Girju acknowledged technology is not where it should be for today’s healthcare, particularly in relationship to empathic communication, given the shift to online interfaces and telemedicine. By combining AI research with emotion theories in humanities research, Girju’s project addressed this by designing and building an emotionally intelligent AI interface for patient-doctor interactions. To help medical professionals communicate better with patients. The interface was intended to assess medical empathy during the clinical encounter to let the medical professionals know how effectively they were communicating in an empathetic way.

Helen Jury followed on to discuss ‘The Role of Touch through Art Materials and Objects in Communicating Non-Verbal Expression’ and how this major sense has been heightened through covid, even though interpersonal touch and the senses in other ways have been highly compromised. In an art psychotherapy context, touch and objects enable different modes of self-expression. Therefore, artmaking becomes a clinical material, facilitating personal connections and ‘sense making’ through interpersonal touch. The use of this sense in psychotherapy clinical work allows individuals to access unconscious and unscripted feelings, which might never have been articulated before. These messy, non-linear feelings and thoughts, Jury argued, is what art allows for. Due to the pandemic, the move to digital platforms, Jury insisted, can be beneficial for client or patient visual art psychotherapy. This is because it increases the person’s autonomy by being in their own space or environment; subsequent levelling of potential power dynamics in the therapeutic context; provision of the person’s own equipment, materials, and objects; and the potential alteration of the therapeutic relationship in accommodating this.

Linda Miller, who works across clinical medicine, arts practice, and medical humanities, delivered the final paper, ‘Beyond the five senses: tacit knowledge, “Gut Instinct”; Intuition, self-awareness, and imposter syndrome in clinical practice. Embodied practice through the lens of Donald Winnicott and object relations’. Miller argued for tacit and emotional knowledge within healthcare settings, underpinned by Donald Winnicott, identifying the importance of environment and its impact on psyche and personhood. Winnicott argued for a ‘holding environment’ for therapists to create for clients, mimicking the sensorial and subjective relationship one has with a parent. Miller insisted the need for holding environments within the NHS, as staff retention is a severe issue currently faced. This staffing crisis has also led to a perception of inadequate holding and caregiving for patients. It is a damaging perception, which has led to physical and emotional abuse towards NHS staff. This highlighted the need for caregivers to also be cared for, in the recognition of the essential nature of their role. Jury explained an aspect of their work is coaching doctors through positive psychology and appreciative inquiry. Therefore, by creating opportunities for creativity and play, it is the small actions that matter, allowing doctors to derive pleasure and connect to the real meaning of their work.

The first session of the afternoon was Understanding Sensory Experience. Diana-Andreea Novaceanu started with ‘Laying Down: Experiences of the Ward Bed in Contemporary Visual Arts’. Novaceanu traced numerous examples of ways artists have captured the sensory-scape of the ward bed in contemporary visual arts. Two lithographs of doctors’ portraits from the Wellcome Collection were shown, depicting the stereotypical hospital bed as a place of observation, as well as rest and recovery. Novaceanu talked on the ‘emotional typography’ of clinical spaces, whereby contemporary art has developed its own vocabulary beyond the conventional nineteenth century representations of the clinic and ward bed. Now, the ward has become a hybrid space, serving equal meanings for patient and clinician, public and private, sensory confinement and discovery. Katarzyna Kozyra’s ‘Olympia’ is a half-way imagining of Manet’s painting. The artist looks at us as the nurse looks at her, lying on a white hospital bed, she presents herself during chemotherapy. Novaceanu discussed how Sophie Wellan’s artwork, which is made of actual clinical material, highlighted the complexities and terrifying nature of the ward but also revealed it as a place of hope. Novaceanu concluded by insisting this discourse and arts practice is important for its mediation and insight on the lived experiences of the ward bed.

Ben Lee then spoke on ‘Rethinking the metaphor of sensory “gating” in research about adults living with schizophrenia’. Firstly, Lee introduced the concept of ‘sensory gating’, developed in clinical psychology and neuroscience to describe a characteristic of people living with schizophrenia. It is a process identified in the brain that demonstrates a person’s inability to inhibit or ‘gate out’ repetitive and/or unwanted sensory stimuli. Whilst in neuroscience this can be measured within the brain, Lee argued that we need to know more about its real-world implications. Many of the experiments to measure this activity are undertaken in ‘context free’ environments, which Lee wanted us to move beyond, asking for research between biomedical and interpretivist perspectives to conduct real-world scenarios for more accurate data. The study conducted emphasised lived experience to examine the relationship between the senses and participation in daily activities. By stressing the importance of real-life neuroscience, Lee insisted there are productive benefits of working between biomedical and interpretivist perspectives in medical anthropology, which removes the disconnect between science research and lived, multisensory experiences of schizophrenia.

Uğurgül Tunç and Lucienne Thys Şenocak moved on to talk about ‘Birth as a Sensory Experience: Medicine and Tradition in the Turkish Context’. They discussed the intersection of culture and birth space design in Turkey. There has been little research on birth space design in architecture in Turkey, and existing scholarship tends to be from a functional perspective. Therefore, Tunç and Şenocak used oral history to capture the nuanced experiences of senses, spaces, and emotions that put birth stories at the centre. Whilst cultural practices and their sensorial responses varied, the emotional feeling of losing one’s agency in the birthing space is transcultural and transnational. Having flexibility in the organisation of the birth space had a positive impact on birth experiences. Consequently, Tunç and Şenocak suggested improving birth space design to support diverse cultural practices and requirements to give parents agency to shape the experience.

The final panel of the conference was Feelings, which begun with Sara Honarmand Ebrahimi’s paper ‘Gav-gard and Feeling Safa and Samimiat in a Mission Hospital’. This considered therapeutic landscapes in relationship to colonial hospitals in Iran. Ebrahimi showed us a photograph of a hospital in Kerman that is strikingly set against the surrounding desert and mountains. By drawing on the history of emotions, the paper presented thoughts on what this space would have been like for patients. Whilst there is no access to patient voices, by highlighting the embodiment of architecture, Honarmand argued we can understand emotional experiences of this hospital beyond the physical colonial design. The mountains formed the borderlands of the hospital and at the centre, gav-gard buildings. Ebrahimi explained that the mountains and gav-gard prompt us ‘to unlearn’ how we think about colonial hospital materiality, moving beyond hygiene, light, and ventilation. This helps us to engage with Farsi and Arabic languages to consider the emotional entanglement of place: the mountains and the hospital name became interchangeable, letting patients feel safa and semimat, the profound feeling of delight.

hybrid-presenters

Whitney Wood then considered a North American context in ‘“A Familiar, Not Fearful Place”: Sensory Histories of Natural Birth and the North American Obstetric Ward, 1950-1970’. In the broader context of this period, physicians expressed the need to control the sensory environment of the birthing room. This established male physicians as having a direct influence over the sensescape of the birthing room. Previously, most Canadian births took place at home. Then in the interwar period, birth spaces moved to the hospitals, childbirth was considered a pathological condition, and architecture reflected this for operative and surgical interventions. The heightened anxiety during this period was addressed by the famous female physician Dr Marion Hilliard, who stated that the most distressing force in pregnancy is fear. This prompted a call for prenatal education and led to the dissemination of medical films to reduce ‘maternal anguish’. However, they were not without their controversy and were initially labelled as unsuitable for non-medical audiences. Images circulating of the ideal birth revealed a potent disconnect between the reality and representation of childbirth. During this period, physicians emerged as the arbitrators of the emotional experience of childbirth and of parents.

In the final presentation of the conference, Ariel Ducey and Megha Sanyal discussed their paper ‘Towards the Creative Re-Presentation of What Embodiment Does in Clinical Care’. This transdisciplinary team developed an immersive modelling experience to understand the treatment of pain. Ducey and Sanyal argued that senses and perception are always entwined with what we need to feel responsible. Their immersive installation ‘Moral Horizons of Pain’ created a series of ‘spaces’ to reveal distinct aspects of medical code in treating pain. What emerged from the perspective of the audience was surfaced vulnerability, strong responses, exposure of power dynamics, and the gaps of pain measurement. However, the gendered and racialised dynamics were often palpable and uncomfortable for team members and for audience-participants. Ducey and Sanyal acknowledged that this was confronting, and more work needed to be done to unpack this. Overall, the project considered ways of touching, feeling, and perceiving that we normally take for granted in relationship to pain and healthcare settings. Whilst also creating glimpses of moral dimensions for further work.