A therapeutic garden or wellness garden is an outdoor garden space that has been specifically designed to meet the physical, psychological, social and spiritual needs of the people using the garden as well as their caregivers, family members and friends.
Therapeutic gardens can be found in a variety of settings, including hospitals, skilled nursing homes, assisted living residences, continuing care retirement communities, out-patient cancer centers, hospice residences, and other related healthcare and residential environments. The focus of the gardens is primarily on incorporating plants and friendly wildlife into the space. The settings can be designed to include active uses such as raised planters for horticultural therapy activities or programmed for passive uses such as quiet private sitting areas next to a small pond with a trickling waterfall.
History The American Horticultural Therapy Association (AHTA) Definitions and Positions Paper draws a distinction between a therapeutic garden and a healing garden.American Horticultural Therapy Association, Definitions & Positions (2012). The AHTA defines a healing garden as "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." On the other hand, 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 therapeutic garden can be described as being therapeutic in nature when it has been designed to meet the needs of an individual or group. Individuals or groups strive to improve their well-being through active engagement by using plants and engaging in activities ranging from planting, growing and maintaining plants.
Horticulture has been soothing man's senses as early as 2000 BC in Mesopotamia. Lush agricultural plots lay in the fertile river valleys between the Tigris and Euphrates providing agriculture and inspiration for the first designed gardens in this typical arid landscape.Sir Geoffrey Jellicoe & Susan Jellicoe. The Landscape of Man: Shaping the Environment from Prehistory to the Present Day, London, UK: Thames & Hudson Ltd, 1975. In the 5th century AD, gardens were generally perceived to contribute to the improvement of health and have been used as a place of respite from travels, to serve as a place to recover or recuperate from an illness, or to simply isolate the sick or infirm from the healthy individuals. Gardens located within Christian hospices in the Middle Ages emphasized charity and hospitality. Monasteries ministering to the sick and the insane incorporated an arcaded courtyard where they could find the some shelter, sun, or shade in a human-scale, enclosed setting.Reuben M. Rainey, "The Garden in the Machine: Nature returns to the High-Tech Hospital," SiteLines, A Journal of Place, Volume 5, Number 11, Spring 2010, p.15.
In the 18th to the 19th century, the increased need for hygiene during treatment led to the acceptable uses of "sanitary reforms"Williams G. The Age of Miracles - Medicine and Surgery in the Nineteenth Century. Chicago, IL: Academy Chicago Publishers, 1981. such as cross-ventilation, access to sunlight and gardens. The 20th century ushered in the discovery of germ theory, advances in medical science theories, the biomedical model, and improved technology in the medical sciences.
The biomedical model, derived from Louis Pasteur's germ theory of disease, became the predominant conceptual model used by physicians in diagnosing disease. According to the biomedical model, health constitutes the freedom from disease, pain, or defect, thus making the normal human condition "healthy".George L. Engel, "The Need for a New Medical Model: A Challenge for Biomedicine", Science, New Series, American Association for the Advancement of Science, Vol. 196, No. 4286, 1977, pp. 129-136. The biomedical model of health focuses solely on biological factors, and excludes psychological, environmental, and social influences. This narrow focus rationalized and streamlined not only medical diagnosis but also medical processes. Infection reduction, cost effectiveness and operational efficiency became the norm in the design of medical facilities. "Pressure from insurance companies to minimize hospital stays have largely worked against the provision of actual usable gardens in new or refurbished medical complexes.".Marcus, Clare Cooper and Marni Barnes. Gardens in Healthcare Facilities: Uses, Therapeutic Benefits, and Design Recommendations. The Center for Health Design, Inc. CA, 1995, p. 14. At this time, gardens were no longer perceived as settings that could contribute to the restoration of the patient's health. Nature and gardens were relegated to the beautification of entrances; small "pocket" areas were used as focal points; sidewalks and even parking areas.
In response to the reductionistic scope of the biomedical model, several medical researchers and scientists such as George Engel strongly believed that "…a medical model must also take into account the patient, the social context in which he lives, and the complementary system devised by society to deal with the disruptive effects of illness, that is, the physical role and the health care system. This requires a biopsychosocial model." Since then, the impact of the physical environment on the well-being and health of the patient has received extensive academic research and attention. In 1984, Roger Ulrich conducted a ground-breaking study comparing the positive effect of views of natural scenery, i.e., trees, on the recovery of patients from surgery to patients in similar conditions who were exposed to a view of a brick wall. He was the first to use the standards of modern medical research—strict experimental controls and quantified health outcomes—to demonstrate that gazing at a garden can sometimes speed healing from surgery, infections and other ailments. Ulrich showed that in comparison with the wall-view group, the patients with the tree-view had the following results: shorter post-operative hospital stays; fewer negative evaluative comments from nurses; took less medication, and slightly lower scores for minor post-surgical complications.Roger S. Ulrich. "View through a window may influence recovery from surgery." Science. 1984, 224(4647):420e1 In 1992, Dr. Stokols proposed a concept of health promotive environmentsDr. Daniel Stokols, "Establishing and maintaining healthy environments: Toward a social ecology of health promotion". The American Psychologist, 1992, Vol. 47, pp. 6-22. that involves the physical and social features of the physical environment and how they affect the overall well-being of individuals and groups.
Examples Enid Haupt Glass Garden: Combining horticultural therapy with medical therapy – Built in 1959, the garden is part of the Rusk Institute of Rehabilitation Medicine at New York University. The Rusk Institute is one of the world's leading centers for rehabilitation medicine. Dr. Howard Rusk, a pioneer in rehabilitation of physical disabilities convinced Enid Haupt to donate a greenhouse amidst the increase of returning World War II soldiers and polio patients. The garden started simply as a peaceful retreat from hospital treatment or rehabilitation; but has grown to incorporate a program of horticultural therapy in the 1970s. Trained horticultural therapists work with patients in the therapeutic garden to identify, nurture and learn from plants. Ultimately, the goal is to make therapy seem like a respite.Nancy Gerlach-Spriggs, Richard Kaufman, Sam Bass Warner Jr. Restorative Gardens: The Healing Landscape: Yale University Press, 2004.
Joel Schnaper Memorial Garden: Garden of Hope – Recipient of the 1995 Therapeutic Garden Design Award by the AHTAAmerican Horticultural Therapy Association, http://ahta.org/about/grants-and-awards and the 1995 Merit Award for Design from the ASLA.American Society of Landscape Architects, https://asla.org/AwardRecipient.aspx?id=4958 The therapeutic garden is part of the Terence Cardinal Cooke Medical Center in New York City. In 1989, the center became the first long-term care skilled nursing facility to designate a unit to care for HIV / AIDS patients.Steven Cantor, Contemporary Trends in Landscape Architecture: Wiley Publishing, 1996. The garden "provides opportunity for everyone to connect with nature on their own terms, in their own way and at their own pace, regardless of their capabilities."David Kamp. Healing Garden: Images Publishing Dist AC, 2016. . Built in 1995 and rebuilt in 2004, the Schnaper Garden is a restorative garden, advancing the concept that "properly planned and operated gardens can reduce stress and encourage a sense of well being for long-term health care patients."Steven Kelly & Deanna C Medina, "A Garden of Respite and Nature: The Joel Schnaper Memorial Garden," Landscape Architect and Specifier News, October 2008, Vol. 24, No. 10, p. 62. Designed with an appreciation of changing medical protocols and individual preferences, a series of garden rooms vary in size and character to provide opportunities for structured activities, casual socializing, contemplation, and quiet solitude. A choice of protective settings is offered for individual comfort, ranging from complete shade to full sun. Ease of maneuverability is emphasized to conserve stamina and encourage residents to experience the garden without assistance. The Joel Schnaper Memorial Garden is designed by Dirtworks Landscape Architecture, PC New York, NY.
Mother / Child Garden at Bedford Hills Correctional Facility: Garden of Connection and Compassion –Gardens have been used in U.S. prisons since at least the 19th century for vocational training and therapy.Amy L. Lindemuth. Correctional facilities are often associated with stressful social interactions within stark, imposing institutional settings. Journal of Mediterranean Ecology Vol. 8, 2007. Firma Effe Publisher, Reggio Emilia, Italy: pp87-97. The Mother / Child Garden at Bedford Hills Correctional Facility located in Bedford, New York is part of an innovative program created in 2005 that recognizes family and motherhood as a transformative process for female inmates.Daniel Winterbottom, Amy Wagenfeld. Therapeutic Gardens: Design for Healing Spaces: Timber Press Inc., 2015. The garden acts as a meeting place for mothers and their visiting children to reconnect. It is natural setting that relieves the stresses of incarceration and separation, renewing bonds of nurturing and compassion amidst mature and shady linden trees, newly planted trees, perennial beds, play equipment, arbors and picnic tables. Within this enclosed and safe setting, families enjoy togetherness, free of judgment and the harsh realities imposed on their lives. The Mother / Child Garden is designed by Daniel Winterbottom, RLA, FASLA.