Second Nature - Hospital Art & Design in Japan


"I have always thought that hospitals, those for the Japanese at any rate, need not he sparkling white, that the walls, uniforms and equipment might better be in softer more muted colours. Certainly the patients would he more reposed if they were able to lie on tatami matting surrounded by the sand coloured walls of a Japanese room." - Junichiro Tanizaki "In Praise of Shadows". In the global context of hospital arts and design, Japan offers a welcome alternative to the prevailing westernisation. As in health services elsewhere in the world there is a growing interest in the art dimension. Unlike the moribund UK situation, Japan has experienced a rapid growth in the procurement of new hospitals, with more than 9,500 general hospitals and over 95,000 smaller clinics in Japan. Many however remain in poor condition with inadequate accommodation leaving plenty of scope for creative opportunities. With such a large volume and range of health facilities, it is only possible to provide the briefest snapshot of how artists and architects have contributed towards the new breed of health buildings.

As a result of its ancient cultural inheritance and its centuries of isolation during the Edo Period, artistic values in Japan have developed entirely separately to those of the West. There remains little common ground for agreement amongst the experts when assessments are made on what constitutes a masterpiece. Comparisons between for instance the individual merits of a Rembrandt painting with those of the Roanji rock garden remain unresolved. Basic things we take for granted in the West are seen and understood differently by the Japanese. In Japan space is money and is rarely wasted. Instead of concentrating solely on object making, greater value is placed on spatial arrangements and relationships. Unlike the more linear interpretations of the west, time is traditionally considered to he cyclic. Relatively unaffected by the Christian calendar the average Japanese person is far more aware of and sensitive to the seasonal changes and nature's annual reincarnation. Instead of trying to withstand, control or defeat nature, Shinto promotes living with the ways of nature. In aesthetic and stylistic terms the naturalistic is deemed comparable to the status of the Chinese Classics or Romanticism.

The borrowing or remodelling of nature as in ikebana flower arranging or the laying of a Zen garden are highly regarded art forms. Even during the most ruthless period of the miracle economy and its brutal commercial and industrial development the unselfconscious remoulding of nature still persisted amongst the pocket gardens of the cities and even for example as second nature technology or within the media arts.

Many of the post war artists have engaged with nature or the ritual peculiarities of Japan, from the 'Avant Garde Traditionalists' of the 50's, to the Mono-ha artists of the 80's. Intuition, spontaneity and allusion all thrive whilst illusion, visual trickery or contrivance are less favoured. Not surprisingly artists who explore naturalistic phenomena have found their way into the hospital environment. This includes famous contemporary artists, future artists and those who more modestly continue the traditional crafts.

Amongst the works by the internationally recognised are Susumu Shingu's gravity driven water wheel fountain at the Toyonaka Hospital in Osaka and Aiko Myawaki's flimsy steel rod installations at the Hyogo Rehabilitation Centre which gracefully flex in the breeze. Both Shingu and Miyawaki are artists whose work dynamically interacts with the natural elements and are well located in respite spaces such a courtyards and garden ponds. The emphasis is not biased towards authorship but towards the perceivers who discover their own interpretation of beauty. Further naturalistic contributions include Sculpture Group Q's landmark rockscape at the Hekinan Municipal Hospital. Stone belongs to the ancient Jomon tradition and has a long association with Japanese sensibilities. The massive smooth top boulders informally arranged in a spiral present a safe haven and create a sense of place where people meet or wait. The local authorities have adopted a green city and public art policy and to harmonise the hospital with its lakeside location 30% of the site is allocated to natural vegetation.

It is the intervention of the artist at the early stages of design at the Osaka hospital which gives this mammoth hospital a sense of identity. Here the strategy was to install the artefacts as way-finding devices for the visitors circulation. The works range in sizes from the giant letter 0, the hospital's icon, the forecourt and the street billboards. to the most modest symbols for room identification. The main street junctions feature wrap-round landscapes which link the corridor elevations visually reducing the prominence of the corners. The quality of detail is evident, from the assembly of the timber circle (maru) to expertly crafted wood relief found in the waiting spaces.

Whilst 'serious' art is scarce and rarely associated with hospital environments the popular crafts such as Ikebana and Origami continue to flourish. The lift lobbies at the Tama City Hospital feature a variety of potted flower arrangements. Ikebana is a unique Japanese art form which induces contemplation and delight. The Japanese are a nation of flower lovers and of course shrub and plant arrangements change according to the time of year. The hanging scrolls and flowers of the tokonoka niche of the traditional home are changed to suit the season. At the Kameda Clinic in Kamogawa, art is programmed to create a "comfortable and unrestrained" setting. By incorporating themes from the neighbouring coastline and mountain range, different natural elements are presented on each floor. The annual Tanabata festival is celebrated in each ward with decorative straw and bamboo.

A preferred way of bringing nature into the patient's surroundings is to design it in from the outset. Japanese architecture is renowned for its transparency and its blurred boundaries between inside and out. It is the relationship of the natural habitat to the hospital which deserves further attention. Several new hospitals have successfully introduced a natural ambience into the interior. The Gamagori City Hospital has a delightfully light and airy main entrance which is accentuated by a row of stout trees. The application of external fixtures and fittings such as lamp- posts and banners provide a distinctly non institutional atmosphere. The central light well at the new Sanda City Hospital with its circular external room and traditional bamboo grove landscape is an ideal space for relaxation and contemplation. Tranquil and harmonious spaces which offer exposure to the natural elements are all too rare in modern hospitals and are particularly conducive to long term care. The landscaping incorporated into the famous St Luke's Medical Centre in Tokyo has earned the centre an important urban regeneration award. The large strolling roof garden provides much needed fresh air and exercise space in a dense inner city district which is in desperate need of further greening. Roof gardens provide a welcome extra tier of city habitation and have the potential to reduce pollution levels. For peacefulness and introspection there is a hospital chapel. Here a simple vaulted space is illuminated and animated by the ripples of light reflected from the pool beneath the apse of the chapel onto a flattened arch above the altar. A darkened retreat with waves flickering and dissolving into the shadows provides solace and refreshes the spirits.

In Japanese architecture little distinction is made between the building and its immediate surroundings. The property curtilage and the building envelope are mutually dependent and are automatically integrated within the design process. Designers often adopt a traditional technique known as Shakkei which is to visually borrow the surrounding landscape or scenery but can also he interpreted in a number of others ways such as capturing the local climatic conditions. At the pioneering Shiranui Hospital, the architect, Itsuko Hasegawa was given the brief for each patient to experience the changes in nature from their individual rooms. She designed a very radical unit for the care of stress disease. She contemplated the creation of a holistic environment for the spiritual well-being of the patient. Relocated next to a river of exceptional tidal variations the building became the Seaward Stress Care Centre. An open vista of water, the motion of waves, a reflecting light soothe the patients with the delights of nature. Reflected off the water the sunlight is caught in the translucent kite shape balcony screens forming pulsating interference patterns on the window blinds and curved ceilings. In this unique, organic and diaphanous building the patients are able to experience the changes in tide levels from their bedsides of the natural habitat, its changing rhythms and cycles. The intention was to allow the metabolism to be exposed even subliminally to all kinds of natural phenomena including moon viewing and observing the stars in the night sky through a triangular roof light above the bed. The brief resulted in an unusual cluster of row houses aligned as segments in an amorphous curve along the meandering river. The layout and characteristics of each room and the dimensions of each elevation are different. A subsidiary circulation flow through each room helps to unify the personal space with the common activity spaces. Releasing the patient from physical restrictions and synchronising their biorhythms with those of nature has reduced the use of medication and the length of stay. The only casualty is commercial as less time and medicine means less profit. There is a great deal to learn from the relationship between the patient's condition and this type of experimental therapeutic space. The Seaward Stress Care Centre is being carefully monitored and beginning to reveal very promising results.

Here those responsible for the delivery of health care and the design of hospitals show almost total disregard for the powers of nature. Once inside a typical UK institution the hospital user has no sense for instance of the nuances of the seasons and there are few successful attempts at greening the hospital surroundings. A national disgrace for a nation of garden lovers. Roger Ulrich's renowned claims regarding improved recovery rates by patients with a view of trees has been well publicised but poorly interpreted and never implemented. Withdrawing from the natural habitation is after all contrary to our understanding of personal comfort and well-being. Deliberately isolating the users from contact with nature, health facilities remain artificial and alien environments. A patient-empowered health service should he concerned with bringing treatment nearer to people's everyday lives. The patient will be more at case if the experience of nature with its seasonal variations and modulations are introduced to health care. The alternative is hospitals which remain un welcoming and unhealthy environments. graham cooper

Art & Architecture Journal Summer 1999


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