The effect of treatment environments

Abstract

Although environmental psychology is a relatively recent field of study, the impact of environment on psychological health is a subject already dear to the heart of the media and the public. Hospitals as stressful environments have evoked less clamour than council estates, high rise building, traffic congestion, pollution and disaster zones, but the early studies by sociologists have influenced hospital planning and design. In the past 15 years, psychiatrists have expressed increasing awareness of the effect of hospital and treatment environments though published observations from surgical and medical colleagues remains sparse. Hospital staff soon develop defences to protect themselves in their work environment and become less perceptive of its potential effects on others. Technological advances and the increased use of apparative techniques have accentuated stress and revealed more clearly that clinical reactions to hospital environments do occur. Studies of treatment environments have aimed at identifying either the potentially stressful aspects of the physical and emotional environment or the psychological characteristics of patients which influence adaptation in specific treatment procedures. Mendelsohn in 1956 described acute psychotic reactions in poliomyelitis patients, during artificial respiration in the tank respirator. He ascribed the acute confusional state with hallucinations and delusions to the sensory deprivation of the environment. Improved design has rendered the tank respirator therapeutically obsolete though it is still used experimentally to create conditions of sensory monotony. The advance of open heart surgery was followed by reports of a high incidence of post operative delirium which linked with aspects of the treatment environment. Patients were nursed post operatively in open, well lit recovery areas, immobilised by pain and tubing, encased in a plastic oxygen tent with its monotonous hiss and deprived of sleep by discomfort and observations. Removal from this environment,which combined sensory monotony with sleep deprivation,to the conventional ward setting usually resolved delirium in 1-2 days. Heller's replication study in 1970 revealed a marked decrease in the incidence of delirium which now related to organic features such as severity of cardiac illness, time on cardiac by pass and age. He ascribed this decreasing incidence to modifications in both the physical environment and the psychological atmosphere in recovery units - too late to prevent the emergence of a new