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A

Darin Lane Morris


Spring 2008

S o l d i e r s

G a r d e n :

Increasing Efficacy for Treatment of Returning Veterans


with Post Traumatic Stress Disorder through
Evidence Based Design in the Landscape

Hills and gardens will always be the haunts of him who seeks
to cultivate his original nature; fountains and rocks are a
constant joy to him who wanders whistling among them.



- Kuo Hsi

A Soldiers Garden

This thesis is dedicated to all veterans


and to their care givers. All deserve a place to
heal, a place of dignity and compassion, a place
to be home.

Contents
Section One: Ptsd, Nature And
Evidence Based Design

A Soldiers Garden:
Increasing Efficacy for Treatment of Returning
Veterans with Post Traumatic Stress Disorder
through Evidence Based Design in the Landscape
A new master plan for part of the VA Greater Los
Angeles Healthcare System West LA campus that
improves outcomes for patients, staff and visitors
through enhanced connection and use of the
hospital grounds.
Darin Lane Morris
A Thesis submitted in partial satisfaction of the
requirements for the Professional Certificate in
Landscape Architecture
University of California Los Angeles, Extension

PTSD and Biophilia

Gardens and Healthcare

Therapeutic Pattern Language 13

Section Two: The Project Site


Site Analysis

16

Site Plan and Plan Details

20

Design Concepts

25

Mark Billy, Advisor


Spring, 2008

Acknowledgements:
A special thank you to my advisor Mark Billy for his inspiration
in keeping this thesis process going, and to my incredibly
patient and supportive wife, who is glad to have her husband
back now that thesis has come to completion. Additional
thanks to the community of healthcare garden designers and
horticultural and occupational therapists who have a wonderful
generosity of spirit in seeing this work grow. Also, much
gratitude to Mr. James Duvall, Chief of Government and Public
Affairs at the West LA VA, whose support in opening the doors
at the VA was immensely important to undertaking this thesis;
and finally to the VA staff and veterans who were able to make
invaluable contributions to this thesis.

A Soldiers Garden

Section Three: Narrative And


Discovering The Thesis

Narrative

33

Bibliography

43

SECTION ONE: PTSD, NATURE


AND EVIDENCE BASED DESIGN


What is PTSD?

What is the toll on our brain under stress?

The stress and trauma of war, both sudden


and chronic, dysregulates the bodys
primary stress management system,
causing a negative feedback loop between
proimflammtory hormones, mostly cytokines, and
the neurotransmitters needed to regulate them,
serotonin and cortisols. The latest neuroscience
research with tensor diffusion imaging suggests
that there is physical damage to the delicate
myelin sheaths that enwrap our axons, which are
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the primary communication system of the brain.


To cope with the overwhelming feelings created
by the intensity of endocrinological imbalance,
with the cytokine cycle preventing serotonin
uptake, the answer to achieve balance becomes
more adrenaline, more dopamine release, more
experiences to excite surcreation of feel good
hormones brought on by the rush of the war
experience. The negative cycle is deepened,

and the trauma of war becomes a crutch for the


afflicted solider to feel normal.

What are the symptoms of PTSD?


What is PTSD?

Stress

Survivors of traumatic experience can develop Post Traumatic Stress


Disorder. What is it? The diganosis of PTSD generally focuses on these
three elements.
1. The repeated reliving of memories of the traumatic experience in images, smells, sounds, and physical sensations. These are usually accompanied by extreme physiological states of hyper- and hypoarousal, and by
psychological distress, experiencing trembling, crying, fear, rage, confusion,
or paralysisall of which lead to self-blame and alienation.
2. Avoidance of reminders of the trauma, as well as emotional numbing or
detachment. This is associated with an inability to experience pleasure and
with a general withdrawal from engagement with life.

Central Nervous System

Endocrine System

Immune System

3. A pattern of increased arousal, as expressed by hypervigilance, irritability, memory and concentration problems, sleep disturbances, and an
exaggerated startle response.
Hyperarousal causes traumatized
people to become easily distressed by minor irritations. Their
perceptions confuse the present and the traumatic past. As a
consequence, traumatized people
react to many ordinary frustrations
as if they were traumatic events.

What happens when the veteran returns home - no


longer engulfed by the adrenalin of war?
In the days and weeks that follow, the symptoms of PTSD, often masked in
the field of battle, become apparent back home. Hyperarousal, depression,
sleeplessness, anxiety, volatility of emotion and reliving trauma. Unable to
modulate the biological stress response caused by the disorder, maintaining
personal relationships and jobs, functioning as a normal person in society,
becomes increasingly difficult, if not impossible. Up to 1/3 of the suffering
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vets will turn to alchohol and drugs to self-medicate.


In addition to substance abuse, the ongoing burden of chronic stress due
to the disorder itself takes a continuing toll on the bodys immune system.
Studies have shown trends towards higher instances of coronary heart disease, a direct link described by psychoneuroimmunology with causal factors
related to the hormonal imbalance in patients with PTSD. Neuropeptides with
their own independent immunological response cross-talk back to the Central
Nervous System and shut down the bodys other immunological functions.
By an overburden of stress our suseptiblity to sickness rises.


What is the Biophilia?

How do we relieve the burden of stress?

The Biophilia Hypothesis:


Our innate love for Nature,
and its postive physiological effects.
Biophilia suggests that our positive
physiological response to nature is hard-wired
into our DNA. It is evolutionary:

A Soldiers Garden

Beneficial physiological effects that occur


when humans
encounter, observe or
otherwise positively interact with animals,
plants, landscapes or wilderness (lower
blood pressure, higher alpha states, less
need for pain medication)

Exposure to natural environments enhances


the ability to cope with and recover from
stress, cope with subsequent stress and
recover from illness and injury

Observing nature can restore concentration


and improve productivity

Natural environments foster recovery from


mental fatigue and are restorative

Established methods of nature-based therapy


(including wilderness, horticultural and animal-assisted therapy among others) that have
success healing patients who previously had
not responded to treatment (receptiveness to
learning)

People have a more positive outlook on life


and higher life satisfaction when in proximity
to nature (particularly in urban areas)

Precedents: Biophilia and Medicine Working Together

The Therapeutic Garden


These hospital gardens are therapeutic gardens,
designed for specific medical outcomes to
advance positive results in a standard treatment
protocol. This is differentiated from the
generalized concept of a healing garden, which
may be a losely defined idea of a meditative or
serene garden place, and certainly characterized
as being beneficial, does not necessarily have a
specific measurable criteria attached.
Common to all these gardens is that they are
designed to relieve or act as a buffer to the
burden of stress. Waiting rooms, rather than
having vulnerable and nervousness patients
and visitors staring at an interior wall, window
views out to gardens are provided to reduce
anxiousness; taking a group of young disabled
patients into the garden for horticultural therapy,
to touch, smell and look at plants for sensory
integrative and physical therapy; having a place to
stroll for a respite to get one mind off the stress
of being at a hospital; and having shaded places
to sit together to talk for much needed social
support, or for care givers and staff to take a
break from the stress of working in the healthcare
arena.
In additiion to helping people heal faster, the
positive aspects of nature and outdoor space
becomes integral to everyones health and
maintenance of well-being. The reach of these
concepts goes beyond the boundaries of the
healthcare facility.
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What is Biophilia?


History of Gardens in Healthcare

What is the historical role of


gardens in healthcare?

300 BC

900 AD

1750

Greeks: Aesclepius was the Greek God of Medicine and healing. Pilgrims of the cult flocked to
the Temples of Aesclepius that offered rites of
healing. The seeker was engaged at the temple in
an outdoors setting, where priests offered interpretation of dreams and prescribed cures for illness. Pilmgrims then likely were sent to the baths
at the temple to heal.

Mediveal Cloisture Garden: The first gothic infirmaries were run by monks for religious pilgrims
who sought refuge in the healing gardens of the
cloisture. The shaded loggia provided protection
from the elements and healing herbs and medical plants were grown in the center garden. The
outdoor loggia was a place of contemplation and
meditation.

Asylums at the Age of Enlightment: Philanthropy and medicine based on humanity, not
leeches, as well as the idealizations and romanticizing of nature ushered profound hospital reform.
Asylums were designed with great expanses of
planted grounds for patients to calm their minds
and heal within.

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History of Gardens in Healthcare

What is the future of


medicine for the 21st
Century?

?
1850

1950

Civil War and Acute Care: Wartime tent and


eventual permanent hospitals were designed to
allow the beds of patients to be wheeled outdoors
so patients could have fresh air. Fresh air and
being outdoors were part of the regimen for healing.

20th Century Biological Determinism: Medical practice makes great leaps with technological
advances. However, hospitals become sterile
and efficient machines. Doctors are focused on
treating symptoms and curing the disease solely
at the biological level. Subsequently the garden
was forgotten, and designed out of our modern
day healthcare.

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2050

10
21st Century: Medicine and Landscape

An Evolution in Medicine
Re-embracing nature as
the supportive armature
to health, treatment and
recovery.

Spirit

Nature
Body

Mind

21st
Century

Salutogentic Medicine:
Supporting health and
well-being is the priority,
over sole directive to treat
disease.

Late 20th
Century

How is medical practice evolving to bring nature back into


the healing process?
A 21st Century Integrative Medicine: Advances in
psychoneuroimmunology have shown us emprical evidence
for the mind-body connection: how we feel and think has
literal and immediate physiological effect on our bodies.
There is a mind-immune system loop, and what we feel and
experience releases and inhibits different hormones and
neurotransmitters.

Looking to the future, ideas originating from
anthroposophical medicine provide an evolutionary model
that applies the same rigors of hard sciences to the spiritual
arena: all living creatures have spirit and inter-relate and
communicate with eachother on levels that we have yet to
empirically detect. We can hypothesize that this is a spiritual
component to the DNA hypothesis of Biophilia. Walking

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through an old growth forest, one would think the trees


themselves are sentient beings.

And there is an growing trend to salutogenetic
medicine that looks to fostering community health and larger
questions on coherence and quality of life - where doctors are
renumerated for keeping their community healthy, rather than
being paid when people are sick.
The continuum of these movements are re-embracing
nature back into healthcare. Patient-centered care, which
directly calls for reintegrating the garden back into hospitals,
continuing care and community health centers, is having
an increasing role in the modern medical practice. This sea
change is recognized as Integrative Medicine, treating more
than the disease by treating the whole person.

Integrative Medicine:
Treat the whole person.
Recoginzes a spiritual
component.

Body

Mind

Psychoneuroimmunological
Medicine: The mind is
recognized to have direct
effect on the bodys

19th - 20th
century.

Allopathic Medicine:
Biological deterministic.
Treat symptom and disease

physiological systems.
Modern medicine realizes
that how people think effects
their health.

Body

with litttle consideration for


other factors.

What is the language bridge


between landscape architecture
and medicine?
Landscape Architects and Medical Care
Givers need to speak and to understand
each others language.

If youre a doctor, nurse


or hospital administrator,
do you know what these
terms mean?

If youre a landscape
architect, do you know
what these terms mean?

Site Plans
Site Inventory
Design Solution
Program
Design Concept
Site Potential
Working Drawing
Site Analysis
Contours
Specifications

Chief complaint
Treatment protocols
Prognosis
Disease
Infirmity
Diagnosis
Signs
Wellness
Homeostasis
Symptoms
Desired outcomes
Standard of Care
Heatlth

What are the end goals in these professions?


Land Design seeks to satisfy
the needs of the client and
the artistic expressions
of the designer. These
are however not mutually
exclusively. A land designer
may only seek to satisfy his
personal expression or to
only fulfill the desires of the
client. Prevailing wisdom
considers that a good land
designer can do both.

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The goal of medical care


today is to get the quickest
desired outcome. Prevailing
wisdom considers this to
be removal of the chief
complaint. This is the
differential diagnosis, where
many possibilities are
narrowed to one. There is
no artistic intention for selfexpression.

How to approach and integrate


landscape design with nature and
the practice of medicine?
Standard Approach
to Landscape
Architecture

Evidence Based
Design
in Landscape for
Healthcare

Practice of land design


promotes intuition,
novel approaches,
creativity focused on plan
development, few post
occupancy evaluations, and
few long term contracts.

Evidence based practice


stresses repetition,
competency, predictability,
accountability, long-term
contract with patients.

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21st Century: Medicine and Landscape

What processes must be


incorporated into the project?

The Post Occupancy Evaluation is integral to the design


process: to grow the body of knowledge, paving the way to
discover and implement the best possible evidence and design.

A+

A Balanced Approach that


incorporates imagination of the
landscape architect and the requisite
rigor of evidence based design leads to optimal
results: an engaging site that affords a variety
of experiences that fosters positive medical
outcomes for the greatest number of users.

B-

Evidence based only design projects


would produce positive medical
outcomes though may not have the
appeal or interest needed to engage the widest
number of users within the site. Without the
creative eye of the designer, opportunities may be
overlooked, and the goal to provide the greatest
use for the most users would be missed.

Projects based solely on artistic whim


that ignores evidence based design may
look interesting but may completely fail to
provide any positive medical outcome, or worse,
negatively effect users and increase stress.

Using Evidence Based Design as


Supportive Criteria to Construct a
Therapeutic Pattern Language for Garden
Design in Healthcare.

Control
Choice and Privacy. A hierarchy between private and public places offers choice that emowers
a patient to find his comfort zone. When healing, patients need to be empowered to engage or
disengage from other people. Density and opacity, or permeability of enclosure provides choice
for differing levels of engagement. Being able to choose privacy when needed and awareness of
options affords temporary escape from stressors. A healing patient is vulnerable, and being able
to make independent choices is empowering, and further relieves the burden of stress.

Social Support
A setting for social interaction for intimate and for group settings. Being in community with other
patients in group support, or being able to visit with friends and family, it is important to have
somewhere comfortable and somewhere private to go where they will not be interupted by the
other goings-on of the typically busy healthcare service. Social support reduces, dampens or
buffers the stress response. Social support settings require seating and an enclosed space.

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12
A Therapeutic Pattern Language

Based on research conducted on more than 100 healthcare sites, including acute
care hospitals, hospices, and nursing homes, these sites were analyzed with a
number of Post Occupancy Evaluations, as performed by leaders in healthcare
design research, Claire Cooper Marcus and Marni Barnes. Their reseach in concert
with Dr. Roger Ulrich out of Texas A & M Universtiy has developed a foundation for
evidence based design in the landscape that correlates strongly to positive medical
outcomes in the integration of nature and landscape into medical care. From this
criteria the pattern language below was developed as guides to address the needs
of the landscape architect, stake holders and other contributers in understanding and
developing an evidence based therapeutic site design.

Choice for Shelter /


Exposure and Seating
Physical comfort and a variety of seating and environment choices allows the patient to find appropriate outdoor experiences medically suitable to an individual condition. Some medications
preclude patients from being in direct sunlight, so shade is required before being enabled to go
outdoors. Additionally, heliotherapy, exposure to sunlight, has been proven to induce alpha state
response. A presciption of sunshine ten-minutes-a-day is known to help alleviate some symptoms of depression.

Physical Movement
and Excercise
Positive trip destinations encourage movement and engagement outdoors. By stimulating our
endocrinological system in a positive way, excercise reduces stress and alleviates or reduces
depression through the natural release of endorphins and other neurotransmitters.z

13
A Therapeutic Pattern Language

Access to Nature
Nature enables a person to capitalize on his biological pre-disposition to the nature response:
reduces endocrinological stressor enzymes and increases alpha response and relaxation.
Provides restoration to a positive psychological position. Being in a positive nature experience
lowers fear and anger, and creates positive feelings.

Reduction of Intrusive Stimuli


Positive nature effects are negated by low-level, human noise and smoking. Urban noise, such
as helicopters and sirens can negate affective, aesthetic and cognitive effects of the therapeutic, outdoor environment. A perfectly well designed therapeutic garden sited next to mechanical-electrical-plumbing works, like noisy exhaust vents or air conditioning units, can render null
many of the therapeutic benefits the place could offer.

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Prospect and Refuge


View settings to open space with foilage, calm water and verdant plantings has a stress buffering
/ reduction effect. This response is hypothesized to be evolutionary, as the biophilia hypothesis,
that it is embedded in our DNA. This effect is also provided by viewing experiences from high
up, as in surveying a valley from a hilltop. Also, flowers in the prospective view foster the stress
reduction response. Park-like, savannahs, grass and understory at clusters of trees increase the
same nature response.

Plant-rich Landscape to
Hardscape ratio at 70/30
Garden spaces are most effective when plant rich and when the ratio of plant material to hardscape is 70 to 30. The goal is to reach a critical perception of being in nature. While a concrete
patio with a few potted plants may have some benefit, full benefit occurs when the user clearly
perceives himself within an environment dominated by the positive aspects of nature.

14

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15
West LA VA - Project Site

SECTION TWO:
THE PROJECT SITE

VA Hospital Campus
in West Los Angeles
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16
Site Analysis

VA Campus in West LA
The VA Campus occupies 387-acres, bordered by the 405 freeway to
the East, and is bisected by Wilshire Blvd. The campus employs 3,500
employees, and has more than 300 domiciliary beds for institutional
therapeutic residence. The West LA area is urban and dense, and is a direct
contrast to the expansive, unobstucted grounds of the VA. The thesis site is
focused on 15 acres on the North side of campus in the historical Brentwood
Hospital group of buildings.
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Site Conditions

17
Site Analysis

Eucalyptus and Wildlife Canopy

Impassable Barrier

Mature, wildlife canopy confined to Eastern ridge,


and adjacent Veterans Garden is out of sight
from main campus. Veterans, staff and visitors
would benefit from a stronger connection to these
natural areas.

The North-South ridge along Bonsall Dr.


separates the main campus from the benefits of
the Veterans Garden located at the ridge base.
Access is by vehicle, or it otherwise a long,
unprotected walk to get to the garden area.

Sun Exposure and No Privacy

Limited to One Therapeutic Outdoor Site

There is no overhead tree canopy in the campus


area. There are few opportunities for shade, and
no choice for privacy, visual or psychological, from
the public areas of the campus.

Therapeutic outdoor usage is limited to the


Veterans Gardens, located at the base of the
ridge. Users must travel by vehicle to access.
With the exception of a ball field to the North,
there are no therapeutic outdoor destinations.

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Existing Condition Summary

18
Site Analysis

The new masterplan area addresses patient,


staff and visitor needs in a 6-acre area that
contains three domiciliaries and a treatment
center. Directly East of this area down the ridge
is the Veterans Garden and Serenity Park, a bird
rescue actively used in the treatment of PTSD
with the veteran population. The ridge offers
an immense opportunity with its mature and
dense tree canopy. But this space is currently
unused. Otherwise, the project site is flat with
little vegetative verticality, canopy or horizontal
cover. The site typology is turf abutts institutional
building. There are no gardens for use adjacent
to any programmed buildings on the main
campus.

Proposed Condition Solution


Employ integrated gardens and nature to the
following benefits:

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Reduce the burden of stress due to illness


Increase efficacy of standard treatment
protocols
Foil negative aspects of bureaucratic
and institutional setting - to predispose
patients to the benefits of nature and
assist in openess to treatment

Let the tree canopy spill from the ridge onto the
thesis site, weaving past and through the domiciliaries and treatment center. This will create
opportunities for choice and gradations of private
and public space. It will also establish a stronger
connection to nature as well as a stronger connection to the Veterans Garden at the base of the
ridge.

Bring the Tree Canopy onto the Campus

19
Design Solution Concepts

Subordinate structures to landscape


along main axis. Allow nature to dominate user
experience.

Drawing the wildness and canopy of the ridge into the hospital
area will establish a connection to the Vetverans Garden and
create an armature for the supportive gardens in and around the
domiciliaries and treatment center.

Establish a Connection Through the Ridge


Develop a horizontal canopy
to provide opportunities for shade and privacy.

Engage hillside and establish connection to the Veterans


Garden. Utilize existing stairs to the North and build ramp
structure down hillside to gardens.
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Allow for multiple outdoor therapeutic


destinations. Adjacency and ease of access
is a large determinator of usage.

20
Site Plan

Site Main Program Areas

Constellation of
Ramps
and Paths

Outdoor
Waiting Room
for Treatment
Center

Serenity Park
Parrot Rescue
Cafeteria and food services

Outdoor / Porch
Treatment
Rooms
ent

tm
207 nd Trea
a
ding
Buil iciliary my
r
Dom ation A
Salv
6
Building 20
Care
Community
ministration
nter and Ad
t
Treatmen Ce

Building 257
Domiciliary and Rehabilitation
New Directions

Grove and
Recreation
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ry
ing 256Domicilia
Build
hiatric
Psyc Center
PTSD

Interstitial
Garden

Veteran
Residential
Courtyard

Backyard /
Wrap Around
Porch

Central Garden

21
Site Plan Detail

Program Details
Building 257 and 206
1. Maintain open turf
areas to allow for flexibility in large outdoor
programming and
gathering.
2. Below grade and at
grade indoor / outdoor
office and therapy
rooms. Extends
building interior into
outdoor garden.
Patio provides
privacy and fresh
air. Non-institutional
setting supports
open communication
between healthcare
providers and patients.
3. Planted shade trellis
for outdoor activities.
4. Back of house and
services.
5. Large tree canopies
provide cover and
shade on open turf.
Tree groupings provide visual interest for
prospect and refuge
views.

6. Shade structures
and small grove
provide cover for
visitors and staff
break areas at front
entrance.
7. Shade structure to
reduce heat gain on
building and to adjust
building perception to
pedestrian scale.

6
Building 20
Care
n
ity
un
m
Com
dministratio
enter and A
C
Treatment

7
5

2
8

8. Outdoor waiting
area at patient and
outreach intake.
9. Tree grid for shade
and privacy.
10. Decomposed granite pad. Weight lifting
and proposed site for
basketball half-court.
11. Seating areas
in interstitial and
public walks provide
opportunities to
enliven space and to
provide social support
for visitors, family, staff
and veterans.

11

10

Building 257
Domiciliary and Rehabilitation
New Directions

3
A Soldiers Garden

Program Details
Building 256

22
Plan Detail

ent

tm
207 nd Trea
g
n
i
a
d
Buil iciliary my
r
Dom ation A
Salv

1. Patient Patio and


private space gardens
for domiciliary. CMU
walls and gates
removed and screened
with plant materials
and small trees.

4. Wrap around back


porch and informal
backyard garden to
humanize scale of
building. Enliven
space and provide for
social support.

2. Interstitial garden
to shade building, and
to provide space for
social support and
choice for resident
vets.

5. Seating areas
in interstitial and
public walks provide
opportunities to
enliven space and to
provide social support
for visitors, family, staff
and veterans.

3. Gradations of private to public space


through loggia to inner
garden, out to trellis
and to street gardens
and paths.

6
3

6. Private patient
gardens for structured
therapy sessions.
Raised turf planter for
wheelchair transition
to turf. Trellis and
small tree screens

Close-in Garden Adjacencies


2

ry
ing 256Domicilia
Build
ic
r
t
hia
Psyc Center
S
T
P D

4
A Soldiers Garden

The garden areas around Building 256 are scaled


to provide a sense of a home scale outdoor
space. Degrees and gradations of privacy are
accomplished by using loggias and a wrap around
porch, This enables the patient to enjoy the
garden without having to be in the garden, and
offers a choice to engage or not to engage with
other people. This sense of prospect and refuge
allows the patient to find a personal comfort zone,
which is paramount to goal of relieving stress.

Program Details
Central Garden

1. Trellis extends use


of domiciliary front garden into more public
garden areas.
2. Chipseal paths
suitable for universal
design and wheelchair
access.

3. Modeled turf mound


for heliotherapy, and
for kinesthetic and
proprioreceptive experiences in physical
therapy.
4. Parking lot reduced
to 30 cars.

3
7

23
Plan Detail

5. Transition garden
path and extension of
ridge canopy, connecting user to bridge
and tree boardwalk to
Veterans Garden and
Serentiy Park.
6. Seven circuit
labyrinth for directed
meditative walking
and visual and cultural
interest. Unique
opportunities become
talking points to
engage patients.
7. Circular walk and
circumambulatory
paths create center
and sense of
spaciousness.

Central Garden and Veteran Stories

A Soldiers Garden

Programming for the central garden is intended


to be flexible - to support the imagination and
creativity of the horticultural, occupational and
physical therapists who are working with the
patients. Having veterans with PTSD personalize
the planting beds provides opportunity for the
veteran to re-discover an original sense of self,
which had been replaced with the trauma and
symptoms of PTSD. Ownership through both
active and passive use as a means for healing
imbues the place as somewhere special on the
campus. Because of its open nature, it is there
to serve patients, staff and visitors, becoming an
opportunity for interaction and communication - a
place where veterans can tell their story, where
getting heard is part of the healing process.

24
Plan Detail

Bridge and Path


to the Veterans Garden

1. Serenity Park Parrot


Rescue. Facility is
used in the treatment
of PTSD through pet
interaction and care.

2. Series of Whisper
Dish stations for listening to birdsong in the
tree canopy.
3. Switchback path
engages the hillside
for walk through forest floor.

5. Mature eucalpytus
grove and wildlife
canopy on ridge.

Bridge and Path


to the Veterans Garden

A Soldiers Garden

4. Constellation of
elevated boardwalks
on piers takes user
into and through
tree canopy down to
Veterans Garden.
Boardwalk grade does
not exceed 5% and
can be traversed by
wheelchair.

The hillside bisecting the thesis site has a 20%


grade with an elevation drop of more than 40
feet over a 200 foot distance. Connecting the
plateau where the domiciliary and treatment
facilities reside with the Veterans Garden below
requires approximately a 1200 foot constellation
of ramps and elevated boardwalk to engage the
hillside at a 5% grade. Despite its distance, the
gesture offers a unique, other worldly, meditative
and serene experience to wander through the
Eucaplytus grove and wilderness that creates the
mileau for the hillside.
Whats more, engaging the hillside with paths
and ramps will provide a much needed physical
connection to the Veterans Garden and to Serenity Park, the parrot rescue. The path and process
of traversing the path itself becomes a healing
process and destination.

25
Design Concepts

Cathedral in
the Eucalyptus:
Birdsong
Whisper Dish

Through a series of listening stations along the bridge path down


the hillside, users can stop, sit
and listen to birdsong with the
sound directed and amplifed
through a parabolic whisper
dish. The whisper dish offers
a unique irony - it was initially
developed during WWI as a
means to detect and follow out
of sight aircraft, and was the precursor to modern radar. Today
the patient will use the technology to enjoy and benefit from
birds siging in the tree tops.

Serenity Park
Located at the base of the ridge is Serenity Park. Serenity Park
is dedicated to veterans suffering from Post Traumatic Stress
Disorder, who can come to work with formerly homeless, abandoned, or abused parrots. It is a symbiotic processs that, through
love and dedication, promotes healing for both the veteran and
the bird.
Homeless veterans returning from duty need to make a gradual
transition back into society and the work force. Working with the
parrots provides a stress-free, peaceful, healing environment.

26
Design Concepts

Using the Verticality of Trees


to Make a Sense of Place

Curving Path
Plus Tree Makes
a Private Place.
A tree trunk on a
curvilinear path allows
for a personal space
beyond the trunk, out
of direct view from the
path of travel. Though
the ground plane
remains open, this
offers an opporunity
for personal space
with a bench, where
before there was none.

Using Verticality to Make No-Place


a Place
Using tree massing and canopy, the flat
landscape typology of the VA grounds is
transformed. Vistas that had been dominated
by the institutional builidings are now groves and
paths. Rather than standing on the asphalt of
an adjacent parking lot, exposed and no-where,
A Soldiers Garden

introducing two human-scaled trees that


one can stand between, now there is a
where there, creating more of a sense
of place than before. By aligning rows of
trees in offset pairs, sense of meandering
path can be introduced. The ground is
still open to a cross plane view, but above
there is protection, a canopy to shade
from the heat of the sun and to offer
opportunity for path and movement.

27
Design Concepts

Universal Access
Many out-patient and VA residential veterans
are disabled. Despite ADA compliance on the
campus, there are few if any garden or nature
experiences that afford any access to person
who is bound to a wheelchair. When designing,
allowing universal access to be a guiding principle
will foster gardens with compassion for all who
need them.

A simple and profound example would be to raise


a water feature up high enough so a veteran in
a wheelchair, or an elderly veteran who cannot
easily bend, can simply put their hand into the
water and enjoy the fountain.

Sensory
Integration

In the same way, planters can be raised giving


easier access to a disabled person, or someone
can stand and garden without having to stoop
down low to the ground. Universal Access means
not disenfranchising anyone from the benefits of
the therapeutic garden.

Principles of Universal Access


1. Equitable Use: The design is useful and marketable to any group of users.
2. Flexibility in Use: The design accommodates
a wide range of individual preferences and
abilities.
3. Simple and Intuitive Use: Use of the design is
easy to understand.
4. Perceptible Information: The design communicates necessary information effectively to
the user.
A Soldiers Garden

5. Tolerance for Error: The design minimizes


hazards and the adverse consequences of
accidental or unintentional actions.
6. Low Physical Effort: The design can be used
efficiently and comfortably.
7. Size and Space for Approach and Use:
Appropriate size and space is provided for approach and use.

In desiging therapeutic
garden space,
engaging all the
senses activates a
sync-ing response
that assists patients
to balance unstable
or volatile mental and
emotive states.
There is a calming
immediacy to putting
ones hand in water,
listening to chimes,
walking on crunching
leaves, or putting
ones hands in the soil
and planting a flower.

Integrating Current Site


Building Typologies

28
Design Concepts

Strengthening the Indoor/outdoor


Connection

Existing building faces offer minimum sun protection and no outdoor connection opportunities.
Windows are small, and views outdoors completely occluded by air conditioning units.

Horizontal shading, trellises and porches are


utilized to mitigate heat gain on the building and
to provide opportunities for indoor/outdoor connection. Porches up to 10 ft in width can comfortably accomodate small groups of patients
to sit outdoors, out of the sun. Room windows
are replaced with sliding glass doors terminating at grade for a direct room-to-porch-to-garden
connection. Adjacent porch structures and trellises also scale the building face down to a less
imposing, pedestrian scale. Rather than being an
imposition on adjacent open space, the building
becomes a supportive wall in defining a garden
space.
A Soldiers Garden

Increase aperature on existing


fenestration to open views and
bring in natural light.
The VA buildings have a design suitable for
the East Coast with cold winters, using small
windows to minimize exposure to inclement
weather. However, this is limiting however for the
temperate climate of Souhern California. These
institutional buildings can afford to open up the
aperatures on the windows to allow in more
light and open views. Natural lighting reduces
depression, and also would allow for veterans to
view directly out into garden spaces to get the
visual connection and benefits of nature.

Design Concepts

Dividing Space
Proxemics and Process

0 to 18
Intimate
18 - 4
Personal
4 - 12
Social

Thumbnail sketches
were employed to
discover how the
grounds could be
turned into rooms and
spaces for the user
groups.v

12 >
Public

Anthropologist E.T. Halls theory of Proxemics


describes a set of measurable distances between
people as they interact, creating cultural, unconsciously structured microspace. Using these
cues, spaces can be designed at varying degrees
to support different qualities of social interaction.
Large spaces can also be divided accordingly to
support a variety of social interactions.

A Soldiers Garden

As large spaces can be divided, the typical flat


outdoor plane of the VA can be divided into
multiple rooms. Courtyards between buildings
can be divided - to support singular meditative
spaces, or can accomodate intimate or large
groups. The grounds become a place for many
and varied uses by many users.

Process and Imagining

29

30
Design Concepts

Discovering a New VA
through Rendering

Birdseye view West down main road over


proposed tree canopy

View North from beneath wrap around porch


at Building 256

View East onto path to central gardens and


ridge walk

View out from front door of Building 256

View East into courtyard garden at Building


256

Birdseye bedroom view East into courtyard


garden at Building 256

View South from sidewalk into couryard garden at Building 256

Standing West of Building 206 looking at


lowered porch area

Birdseye view South from Building 206 down


to transportation shade structure and to
courtyard garden at Building 256

A Soldiers Garden

31
Design Concepts

Exploring Color, Mass and Verticality.


How does the character of the intitution change?

A Soldiers Garden

32

A Soldiers Garden

33
Inspirations and Early Thoughts

SECTION THREE:
NARRATIVE ON
DISCOVERING
THE THESIS

EXPLORATION, WRITINGS
AND SITE RESEARCH
A Soldiers Garden

On Healing and Gardens

When is it that we are ill and how is it that we


heal?

The premise for my thesis A Soldiers
Garden finds roots in the book All Sickness is
Homesickness by Dianne M. Connelly. Home as
metaphor is a place where we feel most whole,
most comfortable and most at ease being who
we are. Home is a place where we have access
to rest and peace, to harmony and balance, to
an abiding center where Being and being meet,
where Self comes face to face with self. Being home is having an inmost large and intimate
sense of self.

Home and Being are synomonous.

The Greeks called Beingparousia
The veritable translation would be a set or cluster
of significations comprising homestead, at-homeness, a standing in and by itself, a self-enclosedness, an integral presentness or thereness.it
is to just this ground that we must strive to come
home.

- George Steiner

A Soldiers Garden


However, when kept away from this
sense of home and when feeling a need to be
there, we are instead made orphans. We become
vulnerable to forces that stress and harm. On
losing the connection to inner self, we become
homesick, we become ill. Uprooted, self-restoration becomes a surmounting challege.

When sick, home is a place of healing.
The journey back to the CentreThe return to
Centre is the journey home, back to the central
hearth. (J.C. Cooper).

Thereby, healing is the process of homecoming. It is a return to a wholeness of self, to reconnect when lost from this inmost person within.

There is no need to run outside


For better seeing,
Nor to peer from a window. Rather abide
At the center of your being
Search your heart and see
The way to do is to be.

- Lao Tze

Lao Tze is telling there is no need to
distract ourselves by looking outside ourselves,
but rather for us to look inside and to search our
hearts. In the spirit of his words, this action to
look within is itself the means to be. Being in this
sense is homecoming. It is the process of healing.

34
Inspirations and Early Throughts


What is the place that fosters this process of homecoming? Where is the place that
supports a recovering patient to return to this
sense of home, to reconnect with self, as part
of the healing process?


Gardens, being and health have had a
long going intimate relationship in both western
and eastern recorded histories. In Judaic, Christian and Islamic religions, paradise is symbolized
as a garden. Buddha received his enlightment
under a Bo tree (Ficus religiosa). Native American belief sees the person, wildlife and landscape
connected at the deepest levels, where each is
one and shares and supports the same web of
existence. From D.A. Careys Hospice Inpatient
Environments: Compendium and Guidelines, For
the pantheist, montheist, or existentialist, nature
provides a symbolic realm for reflection up on
beauty, eternity, timeliness, and the mutabiltiy of
existence.

The first recorded restorative gardens in
the West were cloisture gardens during the Middle
Ages in Europe, where hospitals and monasteries
ministered to the sick and infirmed. The cloisture
garden, a walled inner courtyard, provided shelter,
sun and shade per the needs of the patients, in
an enclosed, safe setting.


Regarding an 11th century hospice in
Clairvaux, France, St. Bernard recorded:

Within this enclousre many and various
treesmake a veritable groveThe sick man
sits upon the green lawnhe is secure, hidden,
shaded from the heat of the day..;for the comfort of his pain, all kinds of grass are fragrant in
his nostrils. The lovely green of herb and tree
nourishes his eyesThe choir of painted birds
caresses his earsthe earth breathes with fruitfulneess, and the invalid himself with eyes, ears
and nostrils, drinks in the delights of colors, songs
and perfumes.

This description applies as much to today as the


11th century. These settings today are referred
to as therapeutic landscapes, healing spaces or
restorative gardens. By our own 20th century
medical research, healthcare gardens are proven
to possess restorative powers, having clearly
demonstrated positive medical outcomes to those
who are exposed to their benefit. In a healthcare
environment, these gardens provide a sense of
order, safety and privacy for those coping with
illness.

A Soldiers Garden

Where has the cloisture garden gone?


There have been revolutions in medicine.
The last sixty years have focused on biological
determinates of illness. Hospitals have become
sterile, efficient machines that addressed the
biological imperative well, but missed addressing wellness for the whole person. Gardens in
healthcare and recovery were scene as an extra;
their benefit less tangible, and so their presence
over time had been wholly designed out of the
modern healthcare environment. However, the
attention and research being given now are recultivating the garden back into modern healthcare.

35
Inspirations and Early Throughts


Gardens have been shown to aid in
clinical treatment (horticultural, occupational,
recreational therapies) from injury and illness (e.g.
Post Traumatic Stress Disorder, physical disabilities); provide a positive distraction from illness
and concerns; reduce stress and blood pressure;
aid in seamless transition from wartime duty in a
home-like setting; normalize the environment and
de- medicalize the setting; improve mood, function and socialization, increase natural absorption
of Vitamin D; and balance circadian rhythms.

A healing garden is a place, a process,
and their intertwining. (Barnes, Marcus) A therapeutic landscape provides a variety of experience
that enable the recovering patient to find the place
that feels most like home. The garden provides a
sanctuary for relief from stress for the patient, his
family and hospital staff. The garden provides a
place that fosters communication on terms by and
for those who need it. It is a safe place to vulnerable, to look within, to commune with the positive
and healing aspects of nature. It is the song of
birds, the rippling pattern of a brook, the scent
of herbs and flowers, and the cool green of leafy
trees and dappled shade. The garden is the passage way to homecoming.

Environmental Context


The West Los Angeles Department of
Veteran Affairs resides on a sprawling 322 acre
park like campus. It is an oasis of rolling hills,
Pre-WWII construction and mature Eucalyptus,
sitting amid more than 3,500 residents per West
LA square mile. As long as the day, it is surrounded by an inching centipede of red brake lights of
bumper to bumper traffic on Wilshire Blvd. and
the intimidable 405 freeway. Tens of thousands
pass by daily mostly unaware of the business of
the VA or its amazing grounds. It is a jewel hidden in the hay.

Despite its dense urbanscape and traffic,
West Los Angeles hosts some of the best climate
of the Los Angeles basin. Its westside mild, kept
in year long balance by the Pacific just five miles
West. Because of the VAs hill like topography,
its unobstructed elevations, as high as 125 feet
A Soldiers Garden

above street level, there is an easy going, uninterrupted breeze across much of the campus. The
Eucalyptus and Sycamore canopy are in constant
sway, always nodding, always inviting. Outside
on the street, it could be a hot, uncomfortable day,
but up into the VA, it is always pleasant. And if its
pleasant at the street, then the VA grounds can
even be heavenly.

Adjacent VA neighborhoods run from
swanky Bel Aire to the North, to an upscale apartment and condominium district of Brentwood to
the North and West; and then to a slightly marginal West LA neighborhood to the South, bordered by Santa Monica Blvd. The VA campus
is divided into a North Campus and South Campus by Wilshire Blvd. The eastern edge of the VA
is hardened by the impenetrable 405 freeway with
the only access though a nearly hidden tunnel
at Constitution Ave and Sepulveda Blvd.
Once inside the VA, it is a curving maze of small,
tangled roadways with more than 90 orthogonal
buildings that seem to be as though tossed onto
the grounds like a scattering of toothpicks. Some
follow contours. Some relate to eachother. But
there is no cohesive plan. There is little sense of
center or orientation. First time visitors can be
easily lost.


The hospital sits as a monolithic block
on the South campus. Adjacent are rolling hills
of manicured turf with a variety of mature trees
and palms. Its an extrordinary park setting next
to the insanely congested Wilshire Blvd. and the

36
Inspirations and Early Throughts

busy thoroughfare to the hospital traffic, but there


are no paths, no where to sit, no welcoming signs
to enjoy the land. Rather there is a sign posted
that says VA Property. Official VA business only.
Keep out. It is a showplace, private front lawn for
the directors and residential staff housing behind
it. As pretty as it is, no one uses this land.

The remainder of the South campus is
open land with no canopy. There is a palm allee
that strikes a perspective southward past parking
lots and dried, undulating berms, recalling a time
when it might have been a lush, dignified approach to the hospital site.

The North campus buildings show their
age by both their historical construction, as far
back as 1899 Victorian clapboard chapel at the
entrance from Wilshire, and unfortunate neglect
and boarding up as well over the generations.
Historical designated buildings however may not
be razed. In time and with funding, initiatives are
underway with the promise to restore much of this
historic core.


Walking the northern most part of the
campus feels like a step back into a time machine. Bones of former courtyards and gardens
connect long arcaded and stately 1930s nouvea
buildings. Some are sleek, architectural marvels,
harkening back to a days of growth and prospertiy
in the United States. Now they are closed due to
asbestos abatement.

The further Northmost reaches terminate at a secretive golf course that commands

a view Eastward to Century City. To the West, a


wide arroyo is an abandoned demarcation zone,
likely a historical stream from the Santa Monica
mountains. Now it runs amok with weeds and
invasives, and backs up to apartment buildings
off Barrington Ave in Brentwood. It cloaks hidden
potentials, as a nature trail or restored habitat.

A quadrangle of buildings made of a nursing home, administration and two domicilliaries
towards the southern central portion of the North
Campus may be mistaken for its center. Its as
center as it can get. A large turf expanse connects the quad, which on occasion hosts outdoor
events. As a space potentially defined by its program and physical edges of the buildings, there is
development potential here.

To the East from the North main campus
is a hidden lower elevation, like a valley floor,
bordered by the elevation change and the 405
Freeway. An unnamed access road leads daily
traffic out to Constitution Ave., past Jackie Robinson Baseball Stadium, leased by UCLA, a Getty
Shuttle Parking Lot, and oil wells still pumping for
Breitbern Energy.

Tucked away beneath a canopy of towering Eucalyptus on this valley like floor, there is the
10-acre hidden gem of the entire VA campus: the
Veterans Garden, hiding in the Northwest most
corner. It feels wholly disconnected from the rest
of the VA and yet may be one of the most humane
and most important healing places of the entire
healthcare facility.

37
Inspirations and Early Throughts


There are few signs announcing the Veterans Garden. To get there, youd have to know
they exist. Despite best efforts, publicity has
been short. The Veterans Garden is the oasis
within the oasis. It is a fully functioning garden
nursery with greenhouses, lath houses and growing grounds. It is home to the Serenity Park Bird
Sanctuary and an increasingly successful weekly
farmers market.

Walking through the Vets Garden I
completely forgot the urbanscape that surrounds
the VA. I was in the country side. There is no
sound of traffic, no signs of the city, no cars and
no tall buildings. Instead, tall trees stand happily
around. The grounds were lush with planting and
crops. A cut flower garden splashes color around,
whose bounty supply bouquets and arrangements for local restaurants and events. There is
a paradoxically large, small holdings area rotating
with seasonal crops. Its a minifarm in the city.
Planting and flower beds weave their way across

A Soldiers Garden

a meandering path. These plants and flowers are


cultivated for use across the VA campus.

There is a well intentioned but haphazard,
small brick path, meant for wheelchair access,
which goes a short stroll into the Vets Garden; but
would likely be mostly difficult to use, its pathway
undulating and uneven; and no one in wheel chair
comes to visit as it is. There are no raised planters for their use, no universal access for those
with ambulatory challenges. There might be a
hidden stairway somewhere in the Eucalyptus
wild behind the cultviated areas that leads up to
the North campus, but all access otherwise is via
the small Davis Rd. via Constitution Ave. by way
of an unnamed access road. Its either a car ride
or very long walk. There are no bike paths, and
currently circulating transportation to meet garden
visitor needs.

However, the Vets Garden is clearly a
diamond in the rough. It is an incredible and
underused resource. As a healing place, it already meets many criteria for a healing garden.
Nature setting. Quiet. Variety of places. It is

already used in integrative occupational therapy,


but isnt necessarily used as fully as it could be
on the psychiatric rehabilitative side that may not
be mandated to occupational therapy. Making it
shine means connecting it better to the rest of the
campus.
History of the Site

West Los Angeles is rich in history. Westwood is the most recognized area adjacent to the
VA grounds. By following the time line below, we
follow a land grant from Spain eventually to a land
developer and entrepeneur, Mr. John Wolfskill,
who eventually becomes the land grantor for the
adjacent VA cemetary in 1889.

According to Wishire Blvd. The Pacific
Branch fo the National Home for Disabled Volunteer Soldiers and Sailors opened in 1888.
These war veterans came to live out their years
commanding a fine view, sheltered from winds
of the north by mountains and open to the ocean
breezes. The Soldiers Home housed as many

as five thousand men in a rambling colony of Victorian barracks surrounded by gardens, fileds and
wild ravines that streamed out of the mountains.

Prior to the Soldiers Home opening, a
thousand marched hundreds of miles to apply for
membership. The majority of the land the campus
is built upon was donated from rancho owned by
U.S. Senator John Percival Jones. There were
broad manicured avenues curved among evergreen trees and flower garderns. Members lived
in domicillaries designed in stick-and-shinglestyle
with attractive verandas overlooking the grounds.

Members tended orchards and grew lima
beans, vegetables and oats for the kitchen. They
kept livestock and a menagerie of other animals,
some for eating and some as pets, among them
kangaroo and cougar.

On Memorial Day, the soldiers would
align in their bristling blue uniforms with their
long grey bears and moustaches. This attacted
tourists, photographs and positive interaction with
the public. President McKinley paid his respects

38
Inspirations and Early Throughts

in 1901, and gave a speech that the government


would care for the men who gave the best years
of their lives to the country. Four months later
McKinley was assasinated by an anarchist in New
York.

South of the Soldiers Home was the
town of Sawtelle, which proffered saloons, gambling halls and a house of prostitution. Veterans
received their pensions in cash, much of which
went to tawdry life in Sawtelle. The Soldiers
Home also became a magnet for women to find
husbands with a pension. The Veterans needed
companionship, and ladies of a certain age
wanted security. A symbiosis was complete. The
Times in 1917 reported a wedding with more than
thirty grandchildren in attendance.

A Soldiers Garden

39
Inspirations and Early Throughts

WESTWOOD TIMELINE
1769 King Carlos III of Spain decided to found
a city in Alta (upper) California.
a.
Sends soldiers and monks to scope area.
b.
Explorer Gasper de Portola camped with
his group at a site near the present day UCLA
campus
1820 Don Maximo Alanis, a soldier in the Spanish Army becomes first property owner as one of
founders of Pueblo de Los Angeles.

1923 UCLA founded by regents, upgrading the


Normal School at Vermont Ave in Los Angeles.

1925 Regents choose Beverly Site for new UCLA


campus. Janss will however not donate land for
new University, so community votes for bonds to
raise money to purchase land from Janss control.
a. UCLA campus originally modeled for picturesque town in Lombardy, warm red brick. Ravine
crossing through and citrus orchards to the South.

b. Janss takes advantage and promotes
Westwood as University based town.

1843 Alanis receives Land Grant from Mexico


Vice Roy via King for 4,438 acres, called Rancho
San Jose de Buenos Aires (the Ranch of Saint
Joseph of the Good Breezes), used as horse
ranch, and where now stands Westwood.

1927 Janss start selling 1-4 acre lots for Holmby


Hills sold. $25K minimum buildings. Review
board critiques efforts to outdo neighboring Bel
Air and Beverly Hills estates.

1884 Rancho was passed along to several owners, eventually to John Wolfskill, a gold and land
entrepreneur (Wolfskill first to develop Escondido
Northwest of San Diego as a multi-crop land), at
$10 per acre.

a. Wolfskill leases land to barley farmers and uses land for sheep grazing, but despite
plans, fails to develop land further.

1920s Westwood promoted as Best Planned


New Shopping District designed by Hardland
Bartholomew, urban planner and team player with
Olmstead brothers to plan Wilshire Blvd. as LAs
main corridor.
a.
Designs Westwood with Faux Mediterranean theme, angled streets, irregular blocks.
b.
Creates enclave feeling. Sited off
Wilshire, buffered by landscape and low shrubs
so passers can catch glimpse of interior, shopping
and village scene.
c.
34 stores in 1929 grows to 452 stores by
1939.

1919 Wolfskill family holds out for cash and eventually sells to Arthur Letts, founder of Broadway
and Bullocks department stores, for $2,000,000
cash.
a. Letts willed the ranch land to his daughter who
subsequently married into the Janss family, developers of Westwood.
b. Promote Westwood Village as western version
of Hollywood. Fox builds movie lot at Pico.
c. Janss subdivide and develop Westwood as
affordable housing, turning tracts of forty to sixty
acres into improved streets with sidewalks. No
single building contractor was allowed to erect
more than a smattering of homes to avoid monotony and to keep diversity of housing.
A Soldiers Garden

1930s 1960s
(1950s) Arnold Kirkeby turns out futher major
redevelopment to the Village and the acceleration
of commercial growth (goes unabated into the
1980s)
a. Westwood develops further as a movie theater
hotspot, and explodes in the 1970s.
1962 - San Diego Freeway opens. Sleepy little
Westwood no more.
1970s - High-rises invade Westwood Village
along with the traffic.
1980s Westwood high profile burns too bright,
attracts gangs, and shooting and crime incidents
sensationalized. Neighborhood councils pressure
to close up night life, and Westwood commercial
success goes south.

A Soldiers Garden

Social and Cultural Context



The West LA VA campus is a Federal
Campus. It is simultaneouly a private campus
but semi-open to the public. How the public can
or should interact with the VA is not defined. It is
a strange mix. There is incredible resource here,
especially in open land, but it is out of the radar
for both the VA and for the public.

The West LA VA has in our modern era
historically been a psychiatric treatment VA facility, although they offer now a panacea of treatment and services, including medicine, neurology,
psychiatry, rehabilitation medicine and surgery.
Additional inpatient units include nursing home
care and domiciliary.physical and rehabilitative
medicine. Their services list is daunting and inspiring to see how much is offered at the campus:

There are three groups that use the VA.
Vets, Staff and Visitors, who may be Vet family or
the public at large..

40
Inspirations and Early Throughts


Veterans and their families: There is a
mix of residential veterans who live full time at
the VA. They live there because they have either
physical or mental impairments that prevent them
the independence to live outside the grounds.
They need full time care. There are also vet residences who are there for short term stays while in
one of the drug rehabilitation programs.

There are also veterans who are hospital
in-patients who stay only in the hospital during
recovery. The Fisher Foundation is currently constructing short-term housing for vet families who
come to stay with their loved ones who require
longer term hospital stays during recovery and
rehabilitation from surgery.

And there are out-patient vets who are
there only for day treatment, who live off campus.
Some arrive daily for work in drug or psychiatric
treatment programs. Some are attending to medical treatment at the hospital.

The VA has a pain treatment center. This
is a magnet to many vets who have drug addition

VA grounds to some degree. The public uses


the Wadsworth and Brentwood Theaters that are
located on the North campus. Recently some
of the public community has found the Thursday
weekly farmers market hosted at the VA Gardens. There is a small dog park off Barrington
Ave on non-connected VA grounds; but the public
however does not use the VA grounds as they
might a park, though the potential is there.
Uses and Needs

and see the services offered as a potential means


to get a fix.

The current homeless estimates for Los
Angeles is that more than 45% of the male homeless are veterans. Many arrive to the West LA
campus from Skid Row seeking treatment. This is
a challenging population, many of whom are dualdiagnosis. Dual-diagnosis means they have both
psychiatric issues in need of medication and treatment in addition to a drug or alchohol addiction.
This can be an aggressive part of the veteran
population, and cause for potential clash between
adjacent upper income neighborhoods and the
problematic percentage of homeless veterans.

Outreach and community care programs
and clinics are always working to bring the homeless veterans in for treatment. Homeless vets set
up small camps around the VA grounds. Community care groups go on periodic round up missions
to bring the veterans in for treatment.

The VA for the Greater Los Angeles Area
Healthcare System employs 10,000.

Staff includes doctors, nurses, clinicians,
volunteers, engineers, administrators, therapists,
and a vast, vast web of support staff. It is a small
city. Anecdotal evidence suggests that medical
staff turn over is high due to job stress.

The public has minimal interaction with
veterans or staff though the public does use the
A Soldiers Garden


I spent one morning interviewing Merle
Fishman who runs the Veterans Garden. She is
an occupational therapist and ceramic artist. The
VA Garden is a work therapy garden. The VA
Garden offers two main programs. A transitional
work program assists a veteran resume a life
that had been truncated, either due to physical
or mental illness, often a result of war. A longterm therapy pogram has no specific work goals
but offers a service pension for veterans who are
unable to work outside the VA due to physical,
cognitive, or mental impairments. The long term
therapy vets will be part of a community living arrangement or in section 8 housing.

The VA Garden is a combined Business
and Therapy Program. The VA provides the land,
electricity, water and services. But payroll for
vets who work the gardens is entirely funded by
horticultural sales of the products produced at the
VA garden.

41
Inspirations and Early Throughts


The VA Garden provides a variety of
tasks so there is always an occupational therapy
fit. It offers a catharsis of working physically, and
the discipline needed to show up for work. Green
house is worked by vets who can stand and work,
and who have physical difficulty getting down onto
the ground. Based on vet personalities, some will
sell flower arrangements at the farmers market or
microgreens to local restaurants.

Working in the VA Garden provides a
return home for many veterans who grew up in
rural areas and may have worked on farms in
their youth. Therapists getting down and working
the earth alongside the vets builds trust in sharing
activities and responsibilities.

Vets who can show willingness and pride
in their accomplishments as well as independence and reliability move on to groundskeeping
for the rest of the VA campus, which is supplied
with plant materials from the VA gardens. The VA
Gardens is a profound starting point for the work
therapy programs, but there is little direct work
done here for treatment of PTSD.

The physical beauty and isolation of the
VA Garden lends itself more so as psychiatric
treatment area. Merle said, Our veterans often
say, The voices dont come hre. The voices are
less here. It is a mini-eden. It offers familiarity
and nothing unexpectd. It is a physically controlled environment. An island.


In the back of the VA Garden the Serenity Park Bird Sanctuary takes in abandoned
pet birds. Large, open aviaries arranged in a
courtyard house makes an outdoor living room,
sheltered by tall tree canopies. Its like the zoo,
but up close and personal. It does not feel like an
institution but an outdoor living room. The sanctuary has seen great success is helping vets with
PTSD. Through interaction with the birds, caring
for them, and for the campanionship they provide,
many vets have started on strong paths to recovery. The therapeutical value of pet interaction is
well documented, as the bird sanctuary increases
the eden effect for the VA Garden.

The largest problem that the VA Garden
encounters is that vets want to stay. Not leaving
is the fantasy. After working here, whod want to
leave? posed Merle. Despite there being other
kinds of jobs in the world for the vets, there is a
great fear of change. It is clear to see how comfortable the vets could become in this work area.

Merle explained that she would love for
more people to visit and use the VA Garden.
Some staff from the hospital have discovered it,
and will come there for lunch. Merle would also
love for the public to visit and shop at the VA Garden. We are invisible! she exclaimed. Everything we print, say or do around here has a map
attached so people can find us.

The Veterans Garden is an amazing,
healing resource hidden within our urban fabric.
This thesis explores how this connection can be
opened to the benefit of the veterans it serves
and to the public that surrounds. Having a
compassionate, caring place in nature within the
confines of the city is an invaluable resource to
allv.

A Soldiers Garden

42
Inspirations and Early Throughts

43
Bibliogrpahy

Bibliography
Alexander, Christopher A Pattern Language: Towns, Buildings, Construction
(Center for Environmental Structure Series)
Frumkin, Howard, MD, MPH, DrPH Healthy Places: Exploring the Evidence
September 2003, Vol 93, No. 9 | American Journal of Public Health
Hersen, Michel & Biaggio, Maryka Effective Brief Therapies, A clinicians Guide
Mihcel Hersen and Maryka Biaggio, Editors
School of Professional Psychology,
Pacific Univeristy, Forest Grove, Oregon
Marcus, Clare Cooper & Barnes, Marni, Editors
Healing Gardens: Therapeutic Benefits and Design Recommendations
(Wiley Series in Healthcare and Senior Living Design): 1988
Maller, Cecily & Townsend, Mardie & Pryor, Anitia & Brown, Peter & St. Leger, Lawrence, Editors.
Healthy nature healthy people: contact with nature as an upstream health promotion intervention
for populations
Health Promotion International, Vol. 21 No. 1
Mitrione, Steve M.D., Clare Apartments: Design and Evalution of a Therapeutic Landscape
for People Living with HIV Disease MLA Capstone Thesis, University of Minnesota, Dept. of
Landscape Architecture, 2006
VA/DoD CLINICAL PRACTICE GUIDELINE FOR THE
MANAGEMENT OF POST-TRAUMATIC STRESS
Department of Veterans Affairs & Department of Defense
Prepared by: THE MANAGEMENT OF POST-TRAUMATIC STRESS Working Group
With support from: The Office of Performance and Quality, VA, Washington, DC
& Quality Management Directorate, United States Army MEDCOM
& The External Peer Review Program
Contractor and Subcontractor:
West Virginia Medical Institute, Inc.
ACS Federal Healthcare, Inc.
Contract Number: V101(93)P-1633
January 2004
Version 1.0
Based on evidence reviewed until May, 2002

A Soldiers Garden

IRAQ WAR CLINICIAN GUIDE


2nd EDITION
Written and Compiled by
National Center for Post-Traumatic Stress Disorder
Contributing authors include (in alphabetical order): Eve B. Carlson, Ph.D., Erika Curran, L.C.S.W.,
Matthew J. Friedman, M.D., Ph.D., Fred Gusman, M.S.W., Jessica Hamblen, Ph.D., Rachel
Kimerling, Ph.D., Gregory Leskin, Ph.D., Brett Litz, Ph.D., Barbara L. Niles, Ph.D., Susan
M. Orsillo, Ph.D., Ilona Pivar, Ph.D., Annabel Prins, Ph.D., Robert Rosenheck, M.D., Josef I.
Ruzek, Ph.D., Paula P. Schnurr, Ph.D., Steve Southwick, M.D., Jane Stafford, Ph.D., Amy Street,
Ph.D., Pamela J. Swales, Ph.D., Casey T. Taft, Ph.D., Robyn D. Walser, Ph.D., Patricia J. Watson,
Ph.D., Julia Whealin, Ph.D.; and Harold Kudler, M.D., from the Durham VA Medical Center.
Editorial Assistant: Sherry E. Wilcox.
Walter Reed Army Medical Center
Contributing authors include (in alphabetical order): LTC John C. Bradley, MC, USA, LTC David
M. Benedek, MC, USA, COL Ryo Sook Chun, MC, USA, COL Dermot M. Cotter, COL Stephen J.
Cozza, MC, USA, Catherine M. DeBoer, MAJ Geoffrey G. Grammer, CAPT Thomas A. Grieger,
MC, USN, Rosalie M. Kogan, L.C.S.W., COL (Ret) R. Gregory Lande, DO FACN, Barbara A. Marin,
Ph.D., COL (Ret) Patricia E. Martinez, MAJ Erin C. McLaughlin, Corina M. Miller, L.C.S.W., COL
Theodore S. Nam, MC, USA, COL (Ret) Marvin A. Oleshansky, M.D., MAJ Mark F. Owens, LTC
(Ret) Harold J. Wain, Ph.D., COL Douglas A. Waldrep, MC, USA.
June 2004
DEPARTMENT OF VETERANS AFFAIRS NATIONAL CENTER FOR PTSD

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