Interview with Dr. Esther Sternberg, Author of Healing Spaces: The Science of Place and Well-Being

Esther M. Sternberg, M.D. is the author of a new book, Healing Spaces: The Science and Place of Well-Being (Belknap Press/Harvard University Press). The book has been reviewed extensively by a broad range of publications and blogs. So rather than write yet another review, I asked Dr. Sternberg for a telephone interview to discuss some the topics specific to landscapes and health. Before joining the National Institutes of Health, Dr. Sternberg was on the faculty at Washington University in St. Louis, MO. She is also the author of The Balance Within: The Science Connecting Health and Emotions, is a regular book review contributor to Science magazine, and lectures nationally and internationally for lay and scientific audiences. You can learn more about Dr. Sterberg on her website,, and you can watch an author interview here. Many thanks to Dr. Sternberg for this illuminating conversation.

Who was your audience for this book? Everybody! This is a crossover book, meaning that it’s for everyone from scientists to “educated laypeople” – non-scientists, anybody who might want to find a healing space. It’s also for architects, designers, students, and other young people – which is why I used more populist language, metaphors, and examples. One of the crucial steps in bridging different disciplines is learning each other’s language. The book has been favorably reviewed across a wide spectrum of journals, magazines, and blogs, from The Lancet, The Scientist, and New Scientist to the L.A. Times and New York Times, to People magazine – which tells me that the book has been successful in reaching a broad audience.

You refer in your book to Roger Ulrich’s seminal “View from a Window” study that was published in Nature in 1984, which made the scientific community take notice of environmental psychology as more than just a “soft science.” Since then, Ulrich and colleagues have been documenting the physiological effects of people’s experience of nature by measuring blood pressure, heart rate, temperatures, etc. How have recent technological advances in neuroscience changed the ways that research on environmental influences is carried out? There are two kinds of research in this area: First, studying whether something works (and under what circumstances), and second, studying how it works. Ulrich’s ‘View from a Window’ and other clinical studies are the former, and neurosience focuses more on the latter. We may already know that people benefit from being in or looking out onto a garden. But why, and how? Is it the light, the color, the movement, or something else? We can now use technology such as MRIs, PET scans, and other brain imaging to try to answer those questions, and to try to tease out which environmental factors are creating which responses.

Is stress reduction the primary reason that passive experience of nature (rather than active experiences, like gardening or exercise) is restorative? Or is there some other way that it is also beneficial? There are two ways that nature (and other environmental factors) can have beneficial outcomes. First, yes, by reducing stress and its negative effects; stress itself does not cause disease, infections, and so on, but it reduces the body’s resistance to illness and disease, harmful viruses and bacteria. So reducing stress can help foster health and healing. But there’s a second important way that nature works: By enhancing the positive. Positive sensory experiences trigger positive responses and reactions. They turn on parts of the brain that are rich in endorphin receptors (and endorphins make us feel good). We can’t actually measure the level of endorphins in a person’s body, but through brain imaging we can see that parts of the brain that are rich in endorphin receptors become active when there is positive stimulus, such as seeing a beautiful vista, or smelling a fragrant plant, or hearing birdsong. Therefore, we can assume that more endorphins are being released. And perhaps this is why gardens and other natural landscapes are so restorative: They provide a multisensory experience in which more than one positive response is triggered – light, color, sound, scent, touch – all combine to a create a rich positive experience.

Can neurological studies now “prove” theories such as those by Stephen and Rachel Kaplan? They argued that we are less stressed by nature than we are by, for example, being on a crowded city sidewalk, because nature elicits “soft fascination” rather than the extreme concentration needed in less naturalistic environments. Yes, theories like the Kaplans’ make sense on a neurological level, because different parts of the brain are activated when you are in a threatening vs. a non-threatening “focused attention” situation. A non-threatening situaton is less emotionally charged, thus requiring less vigilance. In the book, I use the analogy of the maze vs. the labyrinth. The maze is stressful. We don’t know how to get out, we have too many choices, we might get trapped inside – the body’s stress hormone axis [see pg. 98] kicks into high gear. But with a labyrinth, you are not faced with stressful choices. You enter and exit through one point, you can see the whole thing, and you are led on a simple, calming path.

Has any research been done yet on the effects of people walking labyrinths? Not yet. Probably the closest is Eduardo Macagno and Eve Edelstein’s study at UCSD using StarCAVE technology (virtual reality) combined with measuring brain activity through EEGs to study how people negotiate space. In one study, they found that in navigating a building without the usual landmarks, people who could see light and shadow were still able to navigate. When those clues were taken away, people lost their ability to find their way. This kind of study may be able to help with discovering better wayfinding clues for hospitals and nursing homes, even for people with Alzheimer’s and other forms of dementia.

All of it is fascinating and it’s very important for general health, for maintaining health, and for personal health. A lot of data out there in neuroscience research tells us that place matters. We are affected by our environment, and if we manipulate our surroundings to reduce stress and to provide positive responses, we will benefit.

Song for Autumn – A Poem by Mary Oliver

Mary Oliver is my favorite poet right now. I picked up New and Selected Poems Volume Two after reading a piece about her in the New York Times Travel Section. So many of Oliver’s poems – most of them, in fact – are about her observations of and interaction with the natural world. This one seems appropriate for at least half of the world right now:

Song for Autumn

In the deep fall
don’t you imagine the leaves think how
comfortable it will be to touch
the earth instead of the
nothingness of air and the endless
freshets of wind? And don’t you think
the trees themselves, especially those with mossy,
warm caves, begin to think

of the birds that will come — six, a dozen — to sleep
inside their bodies? And don’t you hear
the goldenrod whispering goodbye,
the everlasting being crowned with the first
tuffets of snow? The pond
vanishes, and the white field over which
the fox runs so quickly brings out
its blue shadows. And the wind pumps its
bellows. And at evening especially,
the piled firewood shifts a little,
longing to be on its way.

I found this poem online at Poetry Daily. Visit their website to see many more poems and to learn about who they are and what they do.

Picture of Health – Great new book on healthcare art, with many references to nature

My friend and colleague Henry Domke recently sent me a hard copy of his new book, Picture of Health: Handbook for Healthcare Art. If you think that the subject of art for healthcare may not seem all that closely related to the subject of therapeutic landscapes, think again!

After serving his community in Missouri as a family physician for almost thirty years, Henry decided in 2007 to pursue his passion as a nature photographer full-time. You can see his beautiful images on his website, Henry Domke Fine Art, and if you’re a follower of this blog, you will see some familiar pictures. Henry has always been generous with allowing me to use his images since he believes in what we’re doing here at the TLN. He also has his own excellent blog, Healthcare Fine Art, in which he explores the connection between art and healthcare. The two years of blog entries form the basis of this very informative book; I’ve already referred to it several times, and I refer to the blog often.

Henry believes strongly in a few things. One is the power of nature, and nature imagery, to make people feel good and to to even help sick people feel better. Second is the importance of being a steward of nature: His parents started the Prairie Garden Trust, a 500-acre restoration project on their own land, in the 1970s, and Henry and his wife are dwellers and caretakers of the land and the Trust. Many photographs are taken on the Trusts’ grounds. And last but not least, Henry believes in making decisions that are based not just on intuition, but on facts. This is called Evidence-Based Design (EBD), in which researched and documented evidence about such things as patient outcomes, staff turnover, and hospital safety are used to inform design decisions such as the healthcare facility’s architecture, gardens, programming, and artwork. Many of Henry’s posts deal with this issue, and his blog (and now book) is one of the best resources for healthcare art. It’s also a pretty darn good resource for all designers, artists, and healthcare providers who are trying to introduce more nature into healthcare.

Here’s one quote that illustrates Henry’s motivation for his artwork and his writing:

“As a doctor, I’ve spent a lot of time in hospitals, and I know how stressful they can be. Even in the best of circumstances, such as having a baby, it can be a scary and anxious time. But when you’re experiencing something truly life-threatening, being in a clinical environment can make you feel even worse. What if, instead of that cold space, you could look at images that triggered thoughts of happy times in nature, scenes that transported you mentally to a better place?”

Landscape architects and designers agree with this statement 100%, and we work hard to get real gardens into the healthcare setting. If a picture can make someone feel better, imagine what an escape into a real garden can do! Henry discusses “real vs. represented” in at least two posts, Nature vs. Virtual, and Real Nature vs. Pictures of Nature, which are also published in the book.

I recently discovered another way that Healthcare Fine Art and Picture of Health can useful to landscape designers: Art in the garden. Many healing gardens integrate artwork – tiles, or sculptures, or murals – and it’s often up to the landscape architect/designer to figure out how the art, the hardscape, and the plant material will interact. Henry’s work serves as an excellent guide. Stay tuned for a blog posting on this very subject coming soon to a Therapeutic Landscapes Network Blog near you.

You can order a hard copy, or download a free pdf version, of the book from the Henry Domke Fine Art website.

Mountain Laurel and Russel Wright

Native mountain laurel (Kalmia latifolia) at Manitoga today

I’m lucky enough to live in the lower Hudson Valley, home – among many other wonderful things – of the Russel Wright Design Center in Garrison, NY. When Wright found the property in 1942, it was a former quarry that had been marred by a century of quarrying and lumbering. He made it his home, and began to “heal” the damaged landscape where he lived and worked. He named the place “Manitoga,” which means Place of the Great Spirit in Algonquin. “Over the next three decades, until his death in 1976, he carefully redesigned and re-sculpted Manitoga’s 75 acres using native plants, his training as a theater designer and sculptor, and his innovative design ideas. Though the landscape appears natural, it is actually a careful design of native trees, rocks, ferns, mosses, and wild flowers.”* (He also built a beautiful house and studio there, and made some pretty cool dishware as well).

My favorite examples of healing gardens are those where the designers have done their part to heal the site, and in so doing, have created a place that restores and rejuvenates us, as well.

It’s a beautiful site throughout the year, and when the native mountain laurel is in bloom, it’s simply stunning. Wright once said, “When in full bloom, the mountain laurel reminds me of fields of strawberry ice cream.” Yum. But of course this wouldn’t be the TLDBlog without a caveat, so here goes: Mountain laurel may be beautiful, but it’s also quite toxic! Not for planting in gardens for children, the developmentally disabled, and people with dementia. You can read more about what plants use with caution on the Therapeutic Landscapes Database Plants page.

Beech sapling emerging from quarry stone

Book Review: Open Spaces Sacred Places

The Therapeutic Landscapes Resource Center takes a broad view of therapeutic landscapes, or what we call Landscapes for Health.™ According to our definition, any outdoor space that fosters health and wellness is a Landscape for Health. While we tend to focus more on healthcare design, we see great value in other spaces that put people in contact with nature: Community gardens, sensory gardens, public parks, nature preserves, gardens in prisons, and even indoor gardens and atria. It’s not often that you find a book that covers this breadth of examples, and that’s because there aren’t many organizations out there devoted to supporting this breadth of Landscapes for Health.

Enter the TKF Foundation (, founded in 1996 by Tom and Kitty Stoner. TKF’s mission is “to provide the opportunity for a deeper human experience by supporting the creation of public greenspace that offers a temporary place of sanctuary, encourages reflection, provides solace, and engenders peace.” The T and K stand for Tom and Kitty, and the F stands for “Firesouls,™” leaders and individuals “who have the spark of hope and energy to find a way…to foster the creation of places that can become sacred and embedded in nature.” TKF has worked hand in hand with these Firesouls, often in ongoing relationships that go far beyond just donating funds, to build these open spaces and sacred places (see for more on this).

In the past twelve years, TKF has funded more than 120 projects in and around the Maryland/Washington D.C. area, where the Stoners are based. Twelve of these projects are lovingly described, in words, photographs, and drawings, in the new book Open Spaces, Sacred Places (2008), written by Tom Stoner and Carolyn Rapp. These include nature preserves, vacant lots transformed into community gardens, an arboretum, gardens in healthcare facilities, a prison garden, and even a tree-planting project. 

In each of the gardens, a bench made from recycled pickle barrel wood (originally designed by Chuck Foster and Paul Willey and now created by the inmates at Western Correctional Institution in Cumberland, MD) offers a place for people to sit, reflect, and connect to nature and each other. A yellow journal and pencil are tucked into a built-in pocket beneath each bench, and Open Spaces Sacred Places is filled with journal entries from people of all ages and walks of life who have been touched by the place they are visiting. Here are three examples: “I give thanks to whatever spirits whispered in my ear today and gently led me through the gate of this very special garden. I will try to carry its energy in my heart and consciousness when I am outside the walls,” and “My daddy moved his finger today,” and “Places like this make me feel like everything will be OK.”

Tom Stoner’s inscription in my review copy of Open Spaces Sacred Places was “Be inspired!” And I truly am, every time I look at the book and think about TKF’s amazing work. But we can learn a lot from this book, too, and I’m sure I’ll refer to it again and again. For anyone who has waged the uphill battle of getting something built, especially something that involves the collaborative process with designers and community members and administrators and red tape and bureaucracy, these stories provide something of a road-map, hope, and yes, inspiration.

You can learn more about Open Spaces Sacred Places at this site:, where you can also buy the book. And for those of you who missed the earlier blog posting about TKF, click HERE for a nice article by Anne Raver of The New York Times about the organization.

Remembering Jean Kavanagh

Jean Stephans Kavanagh died peacefully on Friday, January 25, 2008 after a brief battle with cancer.

The first time I met Jean was at a workshop on healing gardens in Portland, OR. She was vivacious, funny, smart as a whip, and had a wonderful Molly Ivins-esque no-nonsense approach. She has been an important leader in the field of landscape architecture and research-based design, and she will be missed.

From the Texas ASLA website:

Jean Stephans Kavanagh

Of Lubbock, TX, a native of Forest Hills, age 61, died peacefully after a
brief battle with cancer on Friday, January 25, 2008. Jean was the daughter
of the late Rita P.(Nehrig) and John G. Stephans. Beloved mother of Douglas
Camann. Sister of Donna Dowd, Carol Appleby, John Stephans, Rita Behr, Greg
Stephans, Mark Stephans, Dan Stephans, Chris Miles, and Noreen Roy. Also
survived by 23 Nieces and Nephews, and 7 Grand-Nieces and Nephews. Born in
Pittsburgh, PA , Jean studied Architecture at Carnegie Mellon University,
Pittsburgh PA from 1964 – 1969. She received her Bachelor of Science in
Landscape Architecture in 1976 and her Masters of Landscape Architecture in
1982 from Cornell University, Ithaca NY. Jean was an Associate Professor in
the Department of Landscape Architecture at Texas Tech University, Lubbock
TX. She joined the department in 1990 after teaching Landscape Architecture
at the University of Massachusetts-Amherst (’82-’89). She was active in
community and professional outreach and has served as an officer of the
Texas Chapter of the ASLA, the Horticultural Therapy Association, Sigma
Lambda Alpha National Landscape Architecture Honor Society, and the Council
of Educators in Landscape Architecture (CELA). Jean pioneered in the study
of the design of therapeutic landscapes in the United States. In 1995, she
was recognized as one of the top women in Landscape Architecture. During the
Centennial ASLA Meeting in Boston, MA, in 1999, she was inducted into the
College of Fellows of the ASLA in recognition of her efforts in this area of
research. Her teaching awards include the Tau Sigma Delta Outstanding
Faculty of the Year in 1996, CELA’s Award of Distinction in Teaching,
Research and Public Service in 1995 and a shared CELA Special Award for
Design Methods in 1982. In 2001, she chaired the national faculty awards
programs for both Sigma Lambda Alpha and CELA. Friends welcome Wednesday 7 –
9 pm and Thursday 2-4 & 7-9 pm at PATRICK T. LANIGAN FUNERAL HOME, 700
Linden Avenue, East Pittsburgh, PA 412- 824-8800. Mass of Christian Burial
in St. Maurice Church, Forest Hills, on Friday at 10am. The family requests
Memorial Donations be made to Texas Tech Foundation (Jean Stephans Kavanagh
Endowment), P.O. Box 42123, Lubbock TX 79409 or, Maryknoll Missionaries, in
care of Robert V. Nehrig, P.O. Box 304, Maryknoll, NY 10545.