Building hope

Can architecture cure cancer? Can buildings make you better? Can space heal? Nah, ’course not. No matter what claims are made for the trade, architecture is only ever the background, the setting for moments in life which may be joyous, momentous, traumatic or tragic. But the idea that architecture can make a difference is as old as civilisation and the newest incarnation of that conception of the power of place and its role in therapy is the remarkable Maggie’s Cancer Caring Centres.

Three new Maggie’s centres, radically different and strikingly conceived, have just opened, and others are on site. One, at Glasgow’s Gartnavel Hospital, is the work of one of architecture’s last remaining intellectuals, Rem Koolhaas and his firm OMA, and looks like a shattered version of a modernist dream of transparency and regularity. The second, in Nottingham, is by the English eccentric Piers Gough, with an interior by Sir Paul Smith, and resembles a novelty teapot. The third, designed by the late Japanese architect Kisho Kurokawa, opened in Swansea this week and evokes the swirling forms of a cosmos in formation. Each centre is extraordinary, charming and challenging and they ask difficult questions.

The architecture of healing was once placed firmly at the heart of the city. The Greeks established a magical city of culture and cure at Epidaurus, a site that set theatre, dream cures and sports against a dramatic coastal landscape. Medieval builders created monastery complexes that embraced vineyards, almshouses, hostels and hospitals (hostel, hospital and hotel share the same etymological root), including the Hospices de Beaune in Burgundy, from where some of the finest wine still flows (then, as now, red wine was regarded as healthy stuff). The Enlightenment produced its own monumental hospitals, such as Les Invalides in Paris and Christopher Wren’s Royal Hospitals in Chelsea and Greenwich.

But something went wrong. Hospitals got more grim and bleak, conflated with workhouses and prisons. In the 20th century, the sanatorium emerged as an archetype of modernity, from Thomas Mann’s The Magic Mountain to Alvar Aalto’s Paimio Sanatorium. It became the symbol of the purging of an old world via the fresh, cool air and light of a crystalline contemporaneity. The magic mountain quickly descended into the medical machine, the hospital as a massive, inhuman mechanism, a place to process patients. And that is what Maggie’s were reacting to. The hospital is a vast ecosystem of technologies and processes. But as a charity concerned with the well-being of cancer patients and their families – as opposed to medical processes – they can afford to think about architecture and atmosphere.

Gartnavel Hospital in Glasgow by Rem Koolhaas

The centres were instigated by Maggie Jencks and have been built into an architectural and medical exemplar by her widower, the architectural writer Charles Jencks. The aim has been to challenge a kind of architecture of inoffensiveness, which has defined the construction of buildings for traumatic situations for decades. Whether it’s a care home or a crematorium, a hospital or a hospice, the default architecture throughout the western world has been an anodyne vernacular moderne. These are then placed in suburban landscapes of golfing aesthetics – neutered nature.

The Maggie’s centres bring architecture back into the foreground; strident, stylised mini-cultural buildings that respond not to anaesthetised modernity but to the explosion of expressive postmodernity. Some of architecture’s most sculptural protagonists have built centres; Frank Gehry in Dundee; Zaha Hadid in Fife; Lord Richard Rogers in London; Sir Richard MacCormac in Cheltenham.

Jencks has a compelling metaphor for the success of the centres. He dismisses any idea of an architecture of healing but he does introduce the intriguing analogy of the placebo. These buildings and gardens might, he suggests, exert some effect not clinically but psychologically, and the placebo effect is measurably real. A 2006 study by the Lighthouse Architecture Centre of patients at Frank Gehry’s Maggie’s centre in Dundee found that the longer patients had spent in the centre, the more positively they viewed their quality of life. It was found that their ability to make small changes in their environment – moving furniture around, opening a window – had a disproportionate impact. It was that control they had been stripped of in the institution.

Indeed, beyond the dramatic architecture the most interesting thing about the centres is this domesticity, an idea of being at home. Each centre is built around a kitchen table, the informal forum for conversation, encouraging patients to make a cup of tea for themselves – the wider philosophy is one of helping yourself within a framework of support. The rooms are familiar in scale, the furniture is comfortable rather than the kind of theatrical stuff architects favour. There are no corridors or flickering fluorescent strip lights. Some spaces encourage chat, others allow patients to withdraw with a book, there are nooks, corners and, always, views out to the gardens.

Jencks, a landscape designer whose works include the extraordinary gardens at Jupiter Artland near Edinburgh and his extensive grounds at Portrack House in Holywood, imbues the gardens with a sense of cosmic order, of the curious correlations between cosmos, creation and cancer.

Paul Smith interior at Nottingham

The landscape at Gartnavel was designed with Maggie by his daughter Lily Jencks, who created a courtyard garden of elegant beauty amid the harsh landscape of the hospital. A centre under construction at Oxford by architect Chris Wilkinson is a tree house, elevated on stilts so that it sits in the wood at the level of the leaves. The centre in Nottingham looks oddly like a face, its four green-tile-clad oval planes presenting a friendly if eccentric façade. Paul Smith’s interior brings his quirky version of Englishness, with floral-clad chairs, vintage lights and specially designed mugs.

These elements create a sense of place. It is this establishment of the Maggie’s centres as particular places, not placeless institutions, that makes them such a critical intervention into the bland lands of PFI-era hospital architecture. These are spaces that make people feel better – which is not the same thing as making them better. They also have a huge impact on the staff who work amid astonishing architecture, feeling they are part of something that is valued, and they communicate that optimism to patients. There is a lesson here for all workplaces.

Maggie’s has also reintroduced an idea of a correspondence between health and the city. With a tendency to displace hospitals from the city and marginalise them, illness becomes symbolically forgotten, exiled. Yet, as we live longer lives, more of us will live with cancer and it will become a chronic condition rather than the death sentence it can still be perceived as.

These are striking buildings that provoke reactions in their reflections on the cosmos, the house of healing and the city. The house used to be the place where we were born, where we fell sick and where we died. Now those momentous events have been institutionalised and the house has become a more neutral container, an asset. The Maggie’s centres offer a chance to re-evaluate the role that architecture can play in the everyday and the extraordinary. It would be as radical a change as they are sparking in healthcare.

Edwin Heathcote is the FT’s architecture critic

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