Community gardens, CSAs, and other “locavore” delights

Gainesville Times article on healing gardens

Healing garden at The Oaks at Limestone nursing home, designed and installed by Fockele Garden Co.

Here are some excerpts from the Gainesville Times article, by Debbie Gilbert of Gainesville, GA (link to the article to read the whole thing and to hear a brief interview with Naomi Sachs, Director of the Therapeutic Landscapes Resource Center)

Healthy Monday: Greenery good for patients, health facilities

Sometimes, nature is the best medicine.

More health care facilities are using the outdoor environment as a way to help both patients and visitors feel better. Known as “healing gardens” or “therapeutic landscapes,” these green spaces have proven to be so beneficial that hospitals and nursing homes have begun incorporating them into their construction plans.

Northeast Georgia Medical Center’s two upcoming additions to its main campus, the Women & Children’s Pavilion and the North Patient Tower, both include healing gardens in their design. And at least one local nursing home, The Oaks at Limestone off Limestone Parkway, has been using a therapeutic garden for several years. There’s a bubbling fountain in the interior courtyard, and colorful native flowers planted throughout the grounds. Strategically placed bird feeders almost guarantee a display of wildlife throughout the day.

“The families really, really love it,” said administrator Dorothy Foster. “The water fountain is really soothing. When residents are able to go outside, they love just sitting and enjoying the sound of the water.” Foster said the nursing home’s employees also find it a relaxing place to take a break.

Naomi Sachs, executive director of the Therapeutic Landscapes Resource Center in New York, said studies have shown that when patients have a view of the outdoors, they need less pain medication and have shorter hospital stays. This knowledge has brought about a revolution in health care design, Sachs said. “In the 1960s, when hospitals got air conditioning and began closing their windows, they kind of turned their backs on the outdoors,” she said. “(But) a lot of research has been done by environmental psychologists, starting in the mid-1970s. It shows that people respond to a wealth of greenery, a really lush environment (rather than to just a few boxed plants).”

“In a hospital setting, where people are very much not in control of their own bodies and their own routines, and there is a huge lack of privacy, naturalistic settings can be an antidote to that,” Sachs said. “It’s a distraction to whatever problem the patient or visitor or caregiver may have.”

While the gardens are beautiful, they’re far more than just a pleasant amenity. “Savvy hospitals are realizing that it helps their bottom line,” Sachs said. The environment also may play a role in why people choose one facility over another. If they had a positive experience, whether as a patient or as an employee, they’re likely to recommend that place to others. “The fact that people are happier can become a marketing tool,” Sachs said. “More and more health care centers are starting to catch onto that.”

“Isn’t every garden a healing garden?” Part II

Healing Garden at Good Samaritan Cancer Center, Puyallup, WA 

KMD Architects; photo by Michael O’Callahan 

Click here for Healthcare Design Magazine’s write-up of this project. 

“A healing garden is an outdoor (and sometimes green indoor) space designed to promote and improves people’s health and well-being. A true healing garden must be successful in fulfilling the design intent.” Naomi Sachs and the Therapeutic Landscapes Resource Center’s working definition of “healing gardens.”  

In my post yesterday, I gave my very broad definition of “Landscapes for Health,” (recap: A Landscape for Health is defined as any landscape that promotes and facilitates health and well-being). And I left you with a cliffhanger, promising to define “healing gardens” today. And none too soon, as I seem to have already caused confusion, as evidenced by Henry’s comment on yesterday’s post and a friend’s email to me:

“So is a playground a healing garden??  (Slightly joking/slightly serious.)  The best way to get my daughter to forget she has teething pain is to take her to the playground and the best way to help mom forget she is tired and overwhelmed is to take her to the playground – her joy makes us both forget the owie.” – K.W.

Is a playground a Landscape for Health? Absolutely, according to my definition and my friend’s experience. But is it a healing garden? Maybe. Depends who designed it, for whom, and why. I agree with Henry that we need a more narrow and specific definition for healing gardens, one that refers to outdoor (and some green indoor) spaces that are designed, preferably with Evidence-Based Design (EBD), to have healing effects on the people using them.

I have a confession: I started the Therapeutic Landscapes Database in 1999, and have been avoiding coming up with a simple, one-or-two-sentence definition for “healing gardens” ever since. I find it to be extremely daunting, and others must, too, because nine years later, there is still no agreed-upon, industry-standard definition that I can blithely quote. Maybe that’ll happen someday soon, but for now there’s a lot of confusion around the terminology. The American Horticultural Therapy Association (AHTA) just recently issued a Position Paper with helpful definitions of some terms including “healing gardens,” “therapeutic gardens,” and “restorative gardens,” among others. I’ve included some of those definitions below, along with other discussions, but today I’ve finally come up with my own working definition, which means that it is still very much subject to discussion and change. I hope people will leave comments and constructive criticism about what I’ve got so far. 

I have a pet peeve about people’s overzealous use of dictionary definitions, but in this case I think that’s a good starting point: 

1. Healing: The Oxford English Dictionary gives four definitions for the verb “heal”:

a. To become sound or healthy again;

b. To cause (a wound, a disease, or a person) to heal or be healed;

c. To put right (differences, etc.);

d. To alleviate (sorrow, etc.).

So “healing” implies making someone well, or at least improving the health of someone who is or was not well.  

Garden: The OED’s definitions for garden are just too darn long for this already-too-long posting, so I’ll just paraphrase: A garden is a designed, or at least cultivated, space, usually outdoors and usually including vegetation. A garden doesn’t have to be gardenesque, but it does have to be designed or cultivated by someone instead of having just evolved that way. So whereas the Grand Canyon might be a Landscape for Health, it would not fit my definition of a healing garden. 

So you put those two definitions together and you get “a designed or cultivated outdoor space that heals people or at least makes them feel better than they did before they encountered the garden.” But we want to also include something about intent, that these gardens were designed specifically to elicit positive outcomes of improved physical, psychological, and/or emotional health. And we also want to say that these gardens were not only designed to be healing, but they actually are (believe me, I’ve seen plenty of examples of designed “healing gardens” that couldn’t possibly be salutary). How about this? 

A healing garden is an outdoor (and sometimes green indoor) space designed to promote and improve people’s health and well-being. A true healing garden must be successful in fulfilling the design intent of healing. Positive outcomes can be achieved through passive experience of the garden (viewing of or presence in the garden) and/or active involvement in and with the garden (gardening, rehabilitative therapy, and other activities).

And then there are all the other terms, like restorative landscapes, and wellness gardens, and therapeutic gardens, but I’m going to save that for another day. 

If you feel like reading more, I would suggest:

1. The American Horticultural Therapy Association (AHTA) recently-released Position Paper on Definitions and Positions:

Types of Gardens 

Healing Gardens 

Healing gardens are plant dominated environments including green plants, flowers, water, and other 

aspects of nature.  They are generally associated with hospitals and other healthcare settings, 

designated as healing gardens by the facility, accessible to all, and designed to have beneficial effects on 

most users.  A healing garden is designed as a retreat and a place of respite for clients, visitors, and 

staff and to be used at their desire.  Healing gardens may be further divided into specific types of 

gardens including therapeutic gardens, horticultural therapy gardens, and restorative gardens.  These 

garden types are likely to have overlap and the following definitions should be regarded as guidelines 

since no two gardens are the same. 


Therapeutic Gardens 

A therapeutic garden is designed for use as a component of a treatment program such as occupational 

therapy, physical therapy, or horticultural therapy programs and can be considered as a subcategory of a 

healing garden.  A garden can be described as being therapeutic in nature when it has been designed to 

meet the needs of a specific user or population.  It is designed to accommodate client treatment goals 

and may provide for both horticultural and non-horticultural activities.  It should be designed as part of a 

multi-disciplinary collaborative process by a team of professionals.  A therapeutic garden may exist on its 

own as an extension of an indoor therapeutic program area or it may be part of a larger healing garden. 


Horticultural Therapy Gardens 

A horticultural therapy garden is a type of therapeutic garden; it is designed to accommodate client 

treatment goals, but it is designed to support primarily horticultural activities.  A horticultural therapy 

garden is also designed in such a manner that the clients themselves are able to take care of plant 

material in the garden. 


Restorative Gardens 

A restoration or meditation garden may be a public or private garden that is not necessarily associated 

with a healthcare setting.  This type of garden employs the restorative value of nature to provide an 

environment conducive to mental repose, stress-reduction, emotional recovery, and the enhancement of 

mental and physical energy.  The design of a restorative garden focuses on the psychological, physical, 

and social needs of the users. 

2. Annalisa Gartman Vapaa has a nice discussion of the definition of healing gardens on page three of her masters thesis, Healing Gardens: Creating Places for Restoration, Meditation, and Sanctuary,”  MLA thesis for Virginia Polytechnic Institute and State University, 2002.

3. Clare Marcus and Marni Barnes on pages 3-4 of Healing Gardens: Therapeutic Benefits and Design Recommendations (see this recent post for more on this book).

4. Jain Malkin in her fabulous new book A Visual Reference for Evidence-Based Design, on pages 4-6, and 132.

5. Henry Domke suggested this definition: “A healing garden is created using design informed by credible research to achieve the best possible health outcomes,” a modification of the recently revised definition of “Evidence-Based Design” from the Center for Health Design

“Isn’t every garden a healing garden?” Part I

According to my definition, a Landscape for Health could be a garden designed specifically for healing, like for a hospital or nursing home (see above), and it could also be any number of other landscapes, designed or “natural,” as long as they make people feel good (in technical terms, Landscapes for Health bring “positive outcomes” that reduce negative factors like stress, high blood pressure, and anti-social behavior, and instead encourage positive and restorative factors like fascination, wonder, healthy social interaction, relaxation and/or physical activity, and a general sense of well-being). A stretch of beach; a clearing in the woods; a park in a city (Central Park being a supreme example); a community garden; a backyard sanctuary; Francie’s fire escape in Betty Smith’s A Tree Grows in Brooklyn; a memorial; an indoor atrium that stays green and lush even when it’s -30 degrees and sleeting outside. Get the picture?  

Central Park, NY, NY

Couldn’t that be just about any landscape, the slightly vexed reporter asked? This is similar to my most-frequently-asked question, which is “isn’t every garden (or landscape) a healing garden?” to which I unfortunately have to answer no. There are plenty of landscapes, both designed and undesigned, that are not conducive to our health and well-being. A few examples that spring to mind would be (see below) most parking lots; many urban and suburban landscapes, including streetscapes; most quarries, clear-cut sections of forests, superfund sites, and other damaged landscapes (brownfields); most of New Mexico in March when the juniper pollen renders anyone even slightly allergic into a tired, sniffling, eye-watering, blubbering mess; and, sadly, many designed gardens, sometimes even ASLA award-winning, magazine-published spaces (yup, just because it looks good in print doesn’t mean it feels good to be there). 

Photo of California foothills housing by Alex Maclean – 

There are plenty of landscapes, and even gardens, that at best are not salutary, and at worst are actually harmful to our physical, emotional, and even spiritual health. So, smarty-pants, you may be wondering, how do you differentiate Landscapes for Health from “healing gardens?” Stay tuned, I’ll try to answer that one tomorrow.

Psst! Wanna buy a book?

If you’re looking for good books on Landscapes for Health, I’ve just added a new feature to the Therapeutic Landscapes Database that allows you to link directly to to buy recommended books. I’ll be adding more books to more pages (like books on labyrinths and attracting wildlife to the Plants and  Related pages), so check back again soon.

Highest on my Recommended Reading list is Healing Gardens: Therapeutic Benefits and Design Recommendations, edited by Clare Cooper Marcus and Marni Barnes (Wiley, 1999), and not just because I wrote the chapter on psychiatric hospitals. 

Healing Gardens is, in my opinion, the most comprehensive book in this field. In addition to chapters on specific populations/types of facilities such as children’s hospitals (by Robin Moore), nursing homes (by Deborah McBride), Alzheimer’s treatment facilities (by John Zeisel and Martha Tyson), hospices (by Clare Marcus), and psychiatric hospitals (Naomi Sachs) – and each one of these chapters has historical background, literature review, case studies, and design recommendations – Marcus and Barnes also include an excellent introductory chapter; a chapter by Roger Ulrich on theory and research; and a chapter called “Getting It Done,” which I always direct people to if they’re thinking about building a healing garden at their facility. Lots of good information on fundraising and other nuts and bolts aspects. You can see a couple excerpts of it here, as well as write up by Todd Bressi and comments by jury members when the book won an award (EDRA/Places Awards for Design, Planning, and Research) in 2000.

One caveat: I recommend this book highly to designers, health and human services practitioners, and students. It’s an excellent resource, like a textbook. However, as Henry Domke pointed out in his review of the book on his Healthcare Fine Art Blog, it’s rich in information, somewhat poor in pictures. If you are a home gardener who wants beautiful photos and text that will inspire you for your own garden, this is not your book. For that, I would recommend the following five books, all of which I have and refer to again and again: 

1. The Healing Garden, by Sue Minter
2. Healing Gardens, by Romy Rawlings
3. Gardens for the Soul, by Pamela Woods
4. The Healing Garden, by David Squire
5. The Healing Garden, by Gay Search

Happy shopping, happy reading.

What’s the Difference? Real Nature vs. Views of Nature vs. Pictures of Nature

One of Henry Domke’s recent blog postings got me thinking again about this question of the experience of nature–real nature vs. views of real nature from a window (as was the case with Roger Ulrich’s 1984 “View From a Window” study*), vs. the view of an image of nature, which Ulrich and others have also studied. Each has proven, quantitatively and qualitatively (or empirically and anecdotally) to be beneficial, and more beneficial than, say, looking at a brick wall or being inside of a cubicle all day long, but how do they differ? Is there a hierarchy in terms of positive outcomes? 

My guess would be that the most benefits would be derived from a person actually being outside, as the Kaplans would probably argue; that the second-most effective option would be a real view of nature, as was the case with Ulrich’s study; and that pictures of nature, while perhaps not as effective as being in nature or viewing real nature out the window, are an effective in concert with the first two, or if the first two are not possible (see here and here for a couple of good articles on pictures of nature).

But we need more research to really find out. Of course, there are also the finer questions within this question about what kind of nature, what kind of views out the window, what kinds of pictures of nature…if anyone knows of some good studies that have already been done, please do send them my way and I will highlight them on the blog and on the Therapeutic Landscapes Database.

*Ulrich, Roger S. (1984). “View Through a Window May Influence Recovery from Surgery.” Science, Vol. 224, No. 4647, April 27, pp. 420-421.

Hot Off the Press: Journal of Therapeutic Horticulture 07-08

Once again, The Journal of Therapeutic Horticulture, published by AHTA, has come out with an excellent publication chock-full of good information (they don’t have an online version yet, but that’s in the works for the future). Kudos to Editor-in-Chief Elizabeth R. Messer Diehl for all of her hard and good work. I’ve been more involved with the American Horticultural Therapy Association (AHTA) since joining the editorial review board last year, and I have to say, I think all landscape architects interested in designing Landscapes for Health should also be members of AHTA. They’ve really got their act together, and as with the Center for Health Design and the Environmental Research Design Association (EDRA), there is a lot of crossover for designers. 
Here are some of the articles in this year’s Journal of Therapeutic Horticulture:
“Effect of Horticultural Therapy on Preventing the Decline of Mental Abilities of Patients with Alzheimer’s Type Dementia,” by Sonia J. D’Andrea, Mitchell Batavia, and Nicole Sasson
“Affordances of Ward and Garden in the Restorative Process of Hospitalized Children,” by Ismail Said and Mohd Sarofil Abu Bakar
“The Psychosocial Benefits of Exposure to Natural Settings in Long-Term Care: An Evaluation of the Wellness Garden Program at Glacier Hills Retirement Community,” by Suzanne Perry Slavens
“The Use of Therapeutic Horticulture in Cancer Support,” by Sheila B. Taft
“Development of Assessment Standards and a Computerized Assessment Tool for Use in Prevocational Horticulture Training Programs for Head-Injured Individuals,” by P.N. Williams, C. Kissel Bales, T.M. Waliczek, and J.M. Zajicek
AHTA Annual Conference Abstracts: “Harvesting Best Practices in Horticultural Therapy.”
While some of these articles are more specific to Hort Therapy, many are also useful to designers in helping to answer questions about what types of spaces are most appropriate for the populations that we serve.  

“Healing Environment” vs. “Healthy Environment”

Okay, I know it was three months ago, but I just came across this interesting discussion on the terminology of “healing environments” vs. “healthy environments” from the Center for Health Design Blog it gives me the excuse to post another picture from Maine:) 

Substituting the word “garden” for “environment” (“healing gardens” vs. “healthy gardens”) helped to clarify it for me. We in the landscape architecture and healthcare design community are still searching for one overarching term and definition for outdoor spaces that promote and facilitate health and well-being. I often use the term “Landscapes for Health” because 
1. It is broad enough to cover any outdoor (and even some indoor) spaces; 
2. It can mean a designed or totally “natural” landscape; and 
3. It can include both passive and active enjoyment of and benefit from contact with nature (e.g., just sitting on the rocks above, breathing in the fresh air and salt water, or gardening at a hospital as part of a horticultural therapy program). 

What say you, dear reader? Healing garden, restorative landscape, landscape for health – what term do you think best sums it all up?

Just back from a week in Maine, my first real vacation in four years. A relief to get out of the sticky Hudson Valley high summer heatwave and up to the cooler climate and untamed nature farther north. One highlight of the trip was an overnight stay on Monhegan Island, where I took this picture. What constantly impressed me, about the flora as well as the fauna (humans included!), is how living things take advantage of whatever growing medium and season they have. Lichen growing on and in even the smallest crevices of rocks, seagulls hunting and caring for their fluffy grey young, humans reveling in the bounty of the season at farmers’ markets. In Maine, there’s no time for the nonsense that we so often get caught up in. The place is remote, the winters are long and harsh. Everything seems to be saying, “This is my life, I’d better make the most of it.” May Sarton, one of my favorite Maine writers, was an avid gardener, and viewed the act of gardening as a way of staying in touch with the rhythms and demands of nature. Here’s how she put it:
“Everything that slows us down and forces patience, everything that sets us back into the slow circles of nature, is a help. Gardening is an instrument of grace.”

Information needed, and a favorite children’s and rooftop garden

I got a request recently from someone who is looking for examples of children’s hospital gardens with rooftop conservatories (in other words, an enclosed space on a rooftop at a children’s hospital). I’ve found many examples of children’s gardens, rooftop gardens, and conservatories, but so far haven’t found all three in one. Anyone out there know of an example? If so, please share by posting a comment! 

In the meantime, here’s an image of one of my favorite children’s gardens that is also one of my favorite rooftop hospital gardens, the Olson Family Garden at the Children’s Hospital, St. Louis, MO (got the image from the Waymarking website:

Landscape Architecture Magazine did a nice article on the garden in 2002, which you can read online:

Also, here’s a video clip about it:  

I visited this garden a few years ago during the ASLA annual meeting with Roger Ulrich, Virginia Burt, Jack Carman, and other colleagues and we were all so impressed. While we were there, a nurse led a small child–who was recovering from severe burns–around the garden. We were moved to see this young patient, wrapped in bandages, maneuvering about the garden, touching the fountains, looking at the flowers, and generally interacting with the world despite the pain. For me, it was one of those “ah-hah” moments when what you do moves beyond the realm of the theoretical and academic. Yes, gardens really are important, especially in hospitals, and they really do make a difference in people’s lives.

I’ll be in Maine for a week starting Monday, with limited internet access, so this is my last post until next week. When I return, I hope to see lots of comments in response to this blog post!