Wellness in urban environments: Empathetic architecture in the era of changes

The XXI century as the era of changes, implies transformation of environments and societies on a global level. Driven by IT as tools conducive for generating novel solutions, it triggered creative rethinking of architecture in order to overcome the stiff dogmatic grip of the twentieth century Modernism. Within these frames we discuss architecture for wellness as the answer to rising resentments regarding living environments. The chronological line-up of theories and ideas regarding architecture for wellness reveals the importance of Men as the ultimate measure of designers’ accomplishments. Architecture is analysed as a catalyst for channelling empathetic feelings and support. Through design examples grouped in three distinct categories ranging from randomly observed details, to nature and IT driven cases, we explain the sensorial and cognitive mechanisms that make them empathetic to human conditions and resourceful as endorsement and promoter of positive changes on personal and societal levels.


Introduction
In year 2021, at the largest-ever UIA congress held in Rio de Janeiro, 104 nations voted for the Declaration that the UIA-PHG (Public Health Group) proposed -to proclaim the year 2022 as the "Year of Design for Health".With this, the topic gained a confirmed status of global relevance and urgency and the profession of architecture the needed boost to address it from both pragmatic and theoretic positions.
In the UIA-PHG, the oldest UIA work program with a tradition of over sixty years, the topic of design for health was always in the focus.However, this focus was not always named as "design for health" nor made relevant for the entire all-encompassing domain of architecture, as it is today.Almost a hundred years ago the Athens Charter set principles that would, as assumed, ensure the healthful cityscapes.Many cities throughout the world based their development on undoubtful belief in those principles, in professional expertise and resulting rigorous standardization.Interest in disease control and risk management, upon which urban design and planning principles regarding public health were set, was in the core of healthcare architecture, institutionalized systems of healthcare and public health programs.
The late Modern brought in some doubts and planted the seed of change.Walter Benjamin's Flaneur announced the mesmerizing rise of The User, the relevance of personal, subjective grasp in shaping the image of the city and the individual's feel about the cityscapes as appropriate for forming the character of the city [1] and for justifying its quality.The notion of health/healthy also changed and wellness and wellbeing, as overarching terms, became more common in scientific discourses.In the specialized area of healthcare design the "patient centric" and later the wider "human centric" platforms were established as pivotal in project briefs while relating to patients, staff and visitors alike.These stands became particularly relevant once their claims were confirmed through rigorous research proving the impact of good design on better outcomes of healing procedures.Biophilia and homeostasis theories, even though known since around nineteen hundred, came into the limelight at the end of the twentieth century.They were positioned as promising game-changers in forming the new design language for healthcare and thus widely popularized.The concurrent development and focus on sustainable design and the more pragmatic energy efficient design came handy in testing the feasibility of biophilic design ideas in healthcare.Going green was regarded successful if energy saving balances were considerably improved.Empathy still did not make noticeable impact in design processes, unless we count-in the design features that could be rather understood as sympathetic (often wrongly equalized to empathetic) and only if solid evidence could prove their positive effects on financial and social capital gains.The Barrier Free and the subsequent Universal Design norms, together with greenery that was formally implemented in cityscapes and healthcare facilities, were typical representatives in this category.
The major change, however, came in mid-eighties with Aaron Antonovsky and his theory of Salutogenesis [2] stating that architecture could and should be generating health while reaching far beyond just mitigating the consequences of its loss, as the pathogenic approach traditionally did.With a plethora of opportunities that Salutogenesis theory opened, architecture entered the twenty first century ready for a radical change.
The synonym for the beginning of the third millennium became the so-called "Post-Truth Era", [3] the popular term that introduced and justified multiple interpretations of taxonomies previously representative of singularity, like truth or reality.Health too became an ideology and oxymorons like "healthy food" or "healthy lifestyle" shaped the image of "new-age" and progress, mainly for the privileged.Empathy did not hit the bar to become relevant for this newly found self-centrism dictated by the "new-age" doctrines.Empathy was instead labelled as rather eclectic and therefore seen as entrenched in the analogue twentieth century, the time when all substances named "food" were a priori considered healthy and safe for consumption and when life was not a branded style, but an account of events documented through rarely doubted media news reports.
Empathy was redundant as obvious in many examples of apparently empathetic and biophilic "green architecture".Greenery was treated as a building material, pasted on the facades, lined up with geometric forms and generally subordinated to the morphology of the built environment rather than to the logic of nature or human perception of it.The rigor and harshness in which nature was merged into design were annulling the very possibility for any empathetic benefits to appear.Cities and buildings were declaratively becoming green, but citizens seldom recognized the assumed goodness.While counting the undisputable paybacks of energy savings, the "green" sustainable architecture and rating tools missed to rightfully award the evidence-based benefits of the exposure to natural light and views to nature for example.At the same time, conforming to the "green label" rules implied cost for compliance and maintenance.
The unprecedented circumstances, like ageing as consequence of the prolonged life expectancy in the developed world, or the IT finally permitting the true globalization, made all boundaries obsolete, including the usual pragmatic approaches to architecture.Radical changes in economies, sciences, societies and generation profiles, from "Baby boomers" to the latest "Gen Alpha" born post 2012, posed a necessity to introduce ambivalence in understanding the nature of the so called "reality" and justify coexistence of multiverses as a new credo.Everything actually seen becomes subordinate to what the multiple interpretations say it is.Even an empath was a recognized term in New Age culture depicting someone centred on own goals, purposes, values, implying being empathetic to self-first and then eventually, but not necessarily to others or to the environment.The prevailing ambivalence and multivalence, thus, on one hand, opened up the possibility for empathetic design, but also allowed the probability of its negation-the dystopic metaverses to appear.Architecture was caught in the paradox inherent to its own nature as Arche (ideas) and Techne (their materialization) became unrelated.Ideas were flourishing while their execution in reality remained bonded to either the "Green" norms (analogue option) or to the powerful yet still very underdeveloped IT (virtual option).
The next opportunity came with the realization that architecture is now leaving the physical footprint as well as the cloud-print [4].Design for empathetic architecture could relate to vague and complex concepts in both real time and in the cloud.Speedy transformations of architecture to fit the human nature suddenly seemed possible and achievable.However, in this era of ambiguity, empathetic architecture could not rely on, or be separately defined by any of the "realities", as none were sufficient per se.Even the practise of analysing the users and their needs became complicated as basics, like gender division, or ethical and moral norms became ambivalent and hard to address.
The prospect of the world in flux, and need for new design appropriate for its emerging transhuman inhabitants is a real possibility.Value of ambiguity is raising, as much as a need to still have the established bar for goodness to be measured upon, or what the antient Greek referred to as "metron" (measure of things, smallest uncountable quantizing particle).

Metron or measure of things for empathetic architecture
Stanford behavioural scientist Professor Robert Sapolsky talked on his (to be published soon) book "Determined -Life Without Free Will" [5] and explained the background of his discourse on the improbability of the free will as all human actions are ultimately predetermined by human nature.The measure of all things indeed is Man and its capability to engage in perceiving, understanding and acting upon events in his environment.Subatomic physicists are claiming that we (humans) are creating the illusion of reality by perceiving it and therefore we could change it too by shear manipulation of reality through the mechanisms of perception and cognition.
Human ability to perceive relies on five primary or essential senses, and on the so-called higher senses, like the sense of balance, language, concept, for example, as defined in diverse classifications.Upon collecting sensorial information, the human brain manipulates the data and sends impulses to organs that need to act upon them [6].From simplest operations based on similarities and equivalences to the most complex ones based on abstract thinking, this process did not change for thousands of years.The same natural instinct (sense of ego) to leave a trace of one's existence led the Neolithic man to leave the imprint of his hand on cave wall and the art student a few years back to paint in gold colour her floor staircase in her housing block (figure 1).In both examples the artists established signs of communication with space and left trace of their presence in it.Cave art remained intact to this day, while the "golden staircase" had to be returned to "normal" since the act was classified under the category of vandalism.Behavioural scientists also recognize that beyond the innate primal instincts, exist the acquired set of societal and cultural norms guiding and curbing our primordial reactions to the environment.In this sense any reference point for empathetic design is not an absolute category, but relative to the given socio-cultural context [7].This set of influences are particularly important as global connectedness and exchange of ideas lead to misunderstanding the so called "evidence based" design as universally applicable.
Example depicting coexistence of the inherent and the adopted criteria for human response to empathetic design is The Kent Vale condominium housing the National University of Singapore's foreign professors.NUS, being a cosmopolitan and highly ranked global University, attracts staff coming from all parts of the world, but for this example we focus on two most numerous groups, the Chinese and the "Westerners".The first group insists on shielding all windows and balconies with dense railings, for the feel of safety, while the latter insist on removing the railings as they trigger discomfort and the feel of imprisonment and restraint.Both groups therefore rely on the "feel" as the main criterion upon which they put up the complains.Here, the two readings of the same design element, the railing, is completely opposite due to the cultural differences that tweak the perception.For the Chinese families, it is positive, relieving and preferential, while for the westerners it is utterly inacceptable.The condominium management accommodated these contradictory requests understanding that they are based on different cultural concepts and thus undisputable.The protective bars are often taken off or put on, depending on apartment tenants' cultural background.
The newest blocks in this condominium (figure 2, b&c) however, have a design feature agreeable to allmovable metal screens perforated to mimic nature, shielding the balconies, creating beautiful reflections and casting shade that changes according to different weather conditions.This empathetic architectural element efficiently cuts the Gordian knot while gaining much more than shear sense of safety or sense of freedom to adapt the space.This design symbolically reflects connectedness to natural habitat, allows choices and adaptability to weather or family circumstances.It also triggers enjoyment in poetical readings of visual effects and the sense of belonging to the wider socio-cultural context of Singapore as the "city in nature".Studies in epigenetics and functions of our primitive brain may better explain the physiological mechanisms triggered by this exemplary design.May be this design element worked well in the same way as any primitive tools used by our Neolithic ancestors did; tools that they freely used to adapt, appropriate and adopt their living space in order to thrive.Therefore, empathetic design needs to address the generic human nature first as intrinsic needs and instincts work beyond the level of different cultural or societal systems and ideologies.

Three ways of addressing empathetic design in the era of change
Even though human perceptive and cognitive mechanisms remain the same, the analogue world around has been rapidly transforming at the turn of Millenniums.New technologies opened opportunities for novel empathetic design concepts to appear, however, models of design thinking and practice intrenched in professional routines did not transform as rapidly.Even in the area of healthcare architecture where empathy would most be expected, only exceptionally designs manage to communicate the empathetic feel.Those projects get awards (figure 3), but concepts take time to be widely accepted.In the following three categories of examples we picture how establishing the feel of empathy matters and has been built through design that triggers the sense of meaningfulness, sense of ego, sense of belonging and freedom, and sense of continuity between urban & nature, private & public, etc.

Randomly observed empathetic design signs in unplanned and planned spaces
Unexpectedly, the Covid crises and need to use non-healthcare spaces for healing revealed more signs of empathy than in regular healthcare institutions.Huge numbers of recovering patients were put in large sport or exhibition halls and other spaces originally meant for diverse functions (figure 4) They were perceived by general public as hardly appropriate for healthcare and the psychological state of patients put in improvised make-shift conditions was questioned.Patients were seen as victims of the unprecedented situation, deserving empathetic and sympathetic treatment.Examples show that patients were given individual cubicles, personalized items and control over lights, details like flowers, newspapers or a la cart food and entertainment in some cases.They were also pitied in public comments online for being served by robots rather than by nursing staff.
Public reactions of this magnitude and the response of health providers has never been noticed in regular healthcare institutions.This empathetic reaction of the society is based on the sense of inappropriateness of the improvised healing spaces.Regular healthcare institutions on the other hand fall into a suitable, accepted frame and thus not questioned.Although research proves that the same feelings of psychological stress and discomfort exist in regular hospitals, empathetic design remains an exception rather than a rule.
The two award winning hospitals in Singapore (Khoo Teck Puat and Ng Teng Fong) are best illustrating these exceptions [8].Their designs fully complied with Green Mark platinum standards, and their biophilic approach matched the overarching concept of Singapore as the "City in Nature".Yet, they are best loved as empathetic healing spaces due to erasing the boundary between nature and healing space, establishing connectedness with the public domain, allowing for privacy and choices, raising the feel of respect as the design was unusual and non-institutional, boosting all the senses through experiencing diverse ambiances in the healing process, etc.

IT and augmented reality driven empathetic design
The second group of examples, picture the potential of IT to build empathetic augmented spaces and/or virtual reality domains as substitute for the stressful non-sympathetic cityscapes, or as its alternative extension.The continuous thrive of humanity to find areas for expansion, and empathetic environments for human species to prosper is intrinsic.Smart city concepts emerging in IT era are seen by many in academic communities as an efficient way of reaching wellness in urban environments.However, the smart city also brings about negative connotations due to hyper control, life driven by manipulation of mega-data, lack of privacy, imposed lifestyles and behaviour, etc.On a positive side the smart city concepts could be the smooth crossover to normalizing life in multiple realities and expanding of the analogue physical reality with augmentations.The hybrid of the "real" and the "surreal" opens up a plethora of possibilities for empathetic design (figure 5).As more contemporaries born and raised in urban settlements suffer from depression, or even thrive for shear survival, the need for escapism and search for experiences laying beyond the real, quotidian life and routines is on a raise.Reaching to the virtual realities supplements the options given in the real world.The point that IT literacy and www availability has been spreading throughout the world regardless of the differences in GDP per capita, make these options conducive and game-changing in architecture of the coming decades.
The novel designs address the sense of flows, networks, nodes, and surfaces, while allowing the commuters to transcend back and forth between and virtual, depending on their changeable moods.The way IT driven architecture communicates is empathetic in essence as it reflects human feelings and aspirations rather than shear needs.An entire new dictionary of architectural terms has been deployed to express the vague and adaptable empathetic designs that has been emerging since.
We may argue that IT and smart cities are still far from being the prevailing model of urban life, and thus still not within reach for many.Although true these arguments, however, do not deny the omnipresent need to support the mental health, societal values, resilience, and survival by escaping to more empathetic and resourceful domains of architecture.New designs with the help of cutting-edge technologies, like 3D printing, nanotech imbedded in composite building materials and others could become themselves more sensorial and potentially more empathetic.

Surreal, yet analogue and empathetic
The most interesting example, however, depicts how this kind of surreal domains could emerge even without employing IT or high-end technologies.In a city state of Singapore, the need to establish a close relation with nature in a limited, dense, and fully urbanized territory was in the core of all of its development plans.From "garden city" to the latest "city in nature' the urban models praised symbiosis with the rich equatorial nature and climate.However, when the continuous green belt was planned (figure 6) meandering for dozens of kilometers through the dense cityscape and connecting the scattered green sites, parks, tertiary forests, or cultivated green housing blocks, the idea was not to melt the green within the built, but on the contrary, to create a distinctly new urban realm of unprecedented character and sensorial value.The case of one segment of the Green link illustrated here, shows that the empathic value of this domain lies in establishing its unique logic, independent of the regular urban matrix that it overlaps with.
Another example is the Alexandra bridge, connecting Green link to the Horticulture Park.This bridge is diagonally and not perpendicularly (as would have been expected) positioned over a regular street thus clearly showing that it does not follow the logic of the urban, the different logic of the Green link realm.While walking on metal bridges meandering through the canopies of the tertiary rain forest trees, one feels detached from the city and, in a poetic way, detached from the real world too.The escapist comforting feel is established without any intervention of IT and yet, fully raising the empathic supportive presence of this unique architectural endeavor.

Lessons learned
The twenty first century, as the era of changes also called the "post-truth era", is picturing the time that legitimizes the coexistence of diverse urban domains of distinct characters and interpretations, forming the living environments.Considering such complex urban constructs emerging in times of already omnipresent global vagueness, the sense of clarity indeed relies on Men and its unchanged nature as the only constant reference point.
For Men, empathy lies beyond physiological and other quantifiable needs, and societal expectations.It rests within the domain of very personal feelings and aspirations that should be addressed in the context of empathetic architecture.It was feelings and aspirations, the two elusive categories fundamental for the sense of wellbeing, that made a difference in quality judgements regarding the examples mentioned in this paper.Both were also recognized as interesting in the context of potentials of IT driven design.
The constant insistence on evidence-based design for wellbeing still persists as the method is justifiable and practical.However, it needs to be enriched by employing tools specific to gathering elusive data and behavioural inconsistencies.With such support, and by evidencing effects of design that employs sensory manipulation and sensorial responses, we may be able to successfully trigger and nurture empathy through design and engage the "smart" technologies in the smart way.

Figure 2 .
Interpretation of nature in the city -from regimented (a) to symbolic and poetic (b&c)

Figure 3 .
Khoo Teck Puat Hospital (a) ward view to roof top garden melted with public domain & Ng Teng Fong Hospital (b) every patient has a view and privacy in multi-bed room.

Figure 4 .
Figure 4. Expo exhibition space converted to comfortable Covid recovery facility, Singapore

Figure 5 .
Figure 5. Augmented reality turning office spaces into hybrid inclusive work environment.

Figure 6 .
Figure 6.The Southern Ridges-Green link preserves the poetics of nature while bypassing the city.