Labyrinths for Healthcare: Approach with Caution

Labyrinth at St. Joseph Memorial Hospital. Photo by Clare Cooper Marcus

St. Joseph Memorial Hospital, Santa Rosa, CA. This labyrinth is appropriate for a healthcare setting since the walking route is relatively short (7-circuit); there are no overlooking windows, and vegetative screening ensures privacy; it is shaded; and a simple explanatory sign explains its use. Photo by Clare Cooper Marcus

This post might invite more invective or controversy than usual (which is usually none, so we’ll see), but it’s something important to discuss: Labyrinths are not always appropriate for healthcare gardens. When they are used, they need to be sited and designed to best benefit garden users. Clare Cooper Marcus and I discuss this issue in our book Therapeutic Landscapes: An Evidence-Based Approach to Designing Healing Gardens and Restorative Outdoor Spaces and some of the text below is excerpted from Chapter 6 (p. 78).

Please understand: I have nothing against labyrinths per se. In fact, in the right place and context, I think they are wonderful and I very much enjoy walking them. The TLN has a page on labyrinths. In our chapter on Gardens for Veterans and Active Duty Personnel, we discuss how labyrinths are used in the therapeutic process (p. 210-211).

First, what is a labyrinth?
The classical labyrinth consists of a continuous path that winds in circles into a center and out again. This basic form dates from antiquity and is intended for contemplative walking. A labyrinth is sometimes erroneously referred to as a maze, which consists of a complex system of pathways between tall hedges, with the purpose of getting people lost. The aim of a maze is playful diversion, whereas the aim of the labyrinth was, and is, to offer the user a walking path of quiet reflection. See this earlier TLN Blog post for more on the distinction between labyrinths and mazes.

Labyrinth at St. Paul’s Anglican Church, Thunder Bay, Ontario, Canada

Labyrinth at St. Paul’s Anglican Church, Thunder Bay, Ontario, Canada

The labyrinth trend
L
abyrinths have become increasingly popular in healthcare settings (hospitals, outpatient clinics, hospices, elder care facilities, etc.). Designers often include them in their plans, sometimes encouraged by the client or the funding donor.

I’m not sure what led to this trend, but here are some guesses:

1. Labyrinths are immediately recognizable as contemplative spaces that encourage silent walking and meditation. Like “Zen gardens,” they symbolize peace and relaxation.

2. They are usually easy to install and, unlike planting beds, require very little maintenance. However, most labyrinths are paved and according to many research studies, people prefer less paving and more plants in healing gardens. So, hmmmmm….

Here is why labyrinths are often not the right choice for healthcare gardens:

1. They take up a lot of space. Space that could be used for plants or a covered gathering area or a more flexible activity space. Because people view labyrinths as somewhat sacred, they are reluctant to walk across them to get from Point A to Point B. Unless the garden is quite large, a labyrinth is probably not the best use of space.

2. Labyrinths are usually not sheltered (by trees or another shade structure). People in hospitals – especially patients – are extremely vulnerable to sun and glare.

3. They take a long time to walk, which may not be good or even possible for some patients. See guidelines, below.

4. They are usually not wheelchair accessible. So people who have limited mobility (anyone in a wheelchair, scooter, walker, or even with a large stroller) can’t use them. Which, especially in a hospital environment, is rather sad.

Labyrinth at Burford Priory, courtesy of St. James's Piccadilly

Labyrinth at Burford Priory, courtesy of St. James’s Piccadilly

Design guidelines
If you do plan to include a labyrinth in a healthcare garden, consider the following design guidelines from Therapeutic Landscapes:

1. The classical labyrinth consists of 11, 7, or 5 concentric circles. The path of the 11-circuit labyrinth is 860 feet long and thus should not be considered for a healthcare garden. Walking that far would likely tax the energy of patients or the time of visitors or staff. The 7- or 5-circuit labyrinth is more appropriate, both in terms of the length of the path and in terms of the space it claims.

2. People walking a labyrinth are in a contemplative, introspective mood and do not want to be stared at. Site the labyrinth in a secluded location out of sight of other garden users and nearby windows.

3. Since some people view the process of walking a labyrinth to be a spiritual experience, site it where others will not be forced to walk across to get from one destination to another.

4. Since many people may be unfamiliar with the purpose of a labyrinth, provide information nearby indicating how to walk the path.

5. Consider a “finger labyrinth” – they take up far less room and can still provide people with a meditative practice.

Finger labyrinth at the American Psychological Association. Photo by Naomi Sachs

Finger labyrinth at the American Psychological Association. Photo by Naomi Sachs

I’d love to hear your comments, and would also love to hear about examples of labyrinths in healthcare gardens that are really appropriate for the place and the people.

Some of the text for this post was excerpted with permission from the publisher, Wiley, from Therapeutic Landscapes: An Evidence-Based Approach to Designing Healing Gardens and Restorative Outdoor Spaces by Clare Cooper Marcus and Naomi A. Sachs. Copyright 2014.