Feb 13, 2014
THEME: Wellness

Posttraumatic Understanding

Architects strive to design buildings in service to others. At Perkins+Will, we are incredibly committed to buildings that promote physical well-being and environmental wellness. One aspect of wellness that architects continue to understand better relates to physiological and psychological health, and how design can effectively address the needs of those with special needs.

Post-Traumatic Stress Disorder (PTSD) afflicts many people but is particularly acute in military veterans.  According to a report (PDF) published by the Congressional Research Service, over 120,000 US military servicemen and women were diagnosed with PTSD between 2004-2012.  Their own sacrifice has been so great, I’ve felt personally compelled to understand this highly complex and multi-faceted condition.

As the name indicates, PTSD stems from a traumatic event that is stored differently in one’s mind than typical memories; traumatic memories are often fragmented, non-verbal, and have an unknown relationship to other memories in time.  They can be isolated and difficult to intentionally recall, yet at the same time they are easily accessed by real-time stimuli similar to the initial event, triggering the memory. The severity of an individual’s symptoms falls on a continuum, most of which are healthy; it’s a survival mechanism to prevent the trauma from happening again.  When symptoms fall outside a given range, it’s considered a disorder.

While PTSD is a psychiatric condition (with myriad variables involved in resolving one’s internal conflict), most psychologists administer a two-step process that involves identifying the trigger of the trauma, understanding what that trauma is itself, and then re-associating the trigger with the present context. With this in mind, we can discover ways to begin designing spaces that facilitate psychotherapeutic wellness.

Training and combat do not make all veterans the same, nor their internal responses to stimuli. The commonality veterans share is rooted in traumas experienced while practicing techniques learned through standardized training with an overarching purpose of remaining alert and surviving in the most stressful of situations. No two traumas are alike, but based on these commonalities, we can identify some similarities in the way many veterans view their surroundings.

I partnered with Corporal Clinton McMahan, US Marine Corp veteran, with whom I got hands-on training of military observational techniques.  This experience allowed me to get a glimpse of the world seen through a veteran’s eyes. Specifically, we looked at methods used to identify threats in indoor and urban conditions because these are the environments most veterans will encounter once back home. In dangerous combat situations, soldiers continuously survey their surroundings for signs of a potential threat. The most miniscule opening in a wall, ceiling or floor, the subtle sign of a trip wire, even a strange sound, smell or expression on someone’s face can be the fraction-of-a-second early warning needed to survive. And the habit of surveying often continues into the transition into the civilian context.

The built environment cannot solve PTSD on its own, but it can help.  When I was working with Corporal McMahan on observational techniques, we visited Safety Wolf Paintball, a recreational combat sports facility.  To add ‘character’ to their facility, the walls are painted to look like bloody hand prints, creating a highly complex, non-repetitive pattern (see below). Whether composed of bloody prints or not, this could easily camouflage potential threats and must be examined carefully. While this specific pattern isn’t something we’d likely see in a Perkins+Will design, a multitude of switches, sensors, rails, moldings, textures, and colors could be equally consuming to a veteran with PTSD.

The author, left, with Corporal McMahan at the Safety Wolf Paintball center, painted with red hand prints.

By simplifying the visual busyness of this hallway, we reduce the stimuli to which the veteran is subjected.  This isn’t intended to prevent the veteran from experiencing symptoms, but to reduce the cognitive load of occupying this space. Within the body’s limited resources, this reduction minimizes the resources allocated to processing environmental stimuli, those resources can then be used elsewhere, such as cognitive-behavioral treatment for PTSD, facilitating a more expedient and permanent resolution.

While this example focuses exclusively on visual cues, we know that a sensation detected by any one of our sensory organs can trigger PTSD symptoms.  In the same collaborative nature that our current practices include engineers, consultants, and end users in the design process, to address this head on we need to embrace the disciplines of psychology, human factors engineering, and military techniques.

As designers, we have it within our power to create spaces for wellness on many levels – environmental and physical not least among them. By examining the case of veterans with PTSD, we can also begin to understand how our work can have a mental effect on the end user, helping create environments that promote holistic wellness.

For more information on this topic, read the full report (PDF) on designing for PTSD. Share your own experience in the comments section.

 The post was authored by Matt Finn.
  1. Clint McMahan
    5:40 pm on February 15, 2014 | Reply

    I still fully support this project and the integral ideas that found it. On behalf of all veterans past and present who have had to re-adjust to “normal” life I hope this project flourishes and the ideas herein are put into action for an increased likelihood of a healthy society. If there is ever anything else I can do to assist, you need do nothing more than ask.

    Clinton R. McMahan

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