This piece provides findings from the author's MLA thesis.
It all began with Marcel Proust.
The “Proust syndrome,” as psychologists term it, refers to the phenomenon of a scent triggering an emotional autobiographical memory—often one from early childhood or adolescence. Proust’s massive 600-page exploration of his life, Remembrance of Things Past, was itself inspired by the smell (and taste) of a madeleine dipped in linden tea, just like his Aunt Leonie used to give him on Sunday mornings. “Immediately the old gray house on the street, where her room was, rose up like a stage set … and the entire town, with its people and houses, gardens, church and surroundings, taking shape and solidity, sprang into being from my cup of tea.”
The growing interest in therapeutic gardens paired with the concern over Alzheimer’s and other memory-related disorders gives rise to considering if scents could be incorporated into gardens for the elderly for the express purpose of stimulating memory. Through understanding the structures and evolution of the parts of the brain that control memory and smell, one can see how smells elicit early, emotional memories. When elderly people talk about their past, these reminiscences allow them to build friendships both with other residents and staff members in group homes.
A more intensive form of therapy, the life review, is a one-on-one process between a therapist and an older person to address mental health issues and achieve “ego resolution,” as Erik Erikson called it. People entering nursing homes are often at risk for depression and suicide ideation. Being cut off from reminders of a previously busy and productive life—frequently due to the death of a loved one, a fall, or a serious illness—can set people adrift and can add to a feeling of uselessness. The curse of “bingo, ball toss and Bible study,” as one doctor puts it, can lead to boredom, hopelessness, and despair.
So where do therapeutic gardens fit in? Existing examples of therapeutic and “memory gardens” were investigated. Patrick Mooney, ASLA, and Joann Westphal, FASLA, conducted pre- and post-occupancy studies of measurable medical conditions, and how gardens can positively impact medical outcomes. In a historical review of therapeutic or hospital gardens, there was a “heart health” plant list for the eighth-century Islamic gardens of the renowned doctor Avicenna.
Architecture can carry aromas as well, deliberately or not. The old damp limestone smell of a medieval cathedral contrasts sharply with what Richard Neutra called the “abstract odorlessness” of modern buildings. Olfactory signatures or “postcards” can immediately bring a place to mind just through scent: lavender fields in Provence or sun-warmed Cognac vaults, for instance.
The second part of the paper consists of interviews with experts in the fields of landscape architecture, horticultural therapy and reminiscence therapy/gerontology. Landscape architects included Brian Bainnson, ASLA; Jack Carman, FASLA; Robert Hoover, ASLA; Catherine Mahan, FASLA; Patrick Mooney, ASLA; Naomi Sachs, ASLA; Rosheen Styczinski, FASLA; Martha Tyson, and Joanne Westphal, FASLA. Horticultural therapists included Nancy Easterling, Rebecca Haller, Teresia Hazen, and Johanna Leos (Mooney and Styczinski are trained in horticultural therapy as well). To round out the medical perspective, interviews were conducted with Betsy Brawley, a designer of architecture and interiors for the elderly; Barbara Haight, a leading expert on reminiscence therapy; Ken Durand, a professor of gerontology and CEO of a Dallas continuing care facility; and Jane Nunnelee and Pauline Youngren, gerontological nurses who have an interest in therapeutic gardens. All of these professions matter, because it takes a team to build an effective therapeutic garden.
Most experts thought scents in the garden could be used to trigger memories, and many had witnessed the power of fragrance to bring a “light into the eyes” of a previously unresponsive elderly person. But gardens or programs designed with this in mind were few and far between; only Teresia Hazen with the Legacy Health System gardens in the Pacific Northwest said they actually use the gardens in life review therapy. It seems that an opportunity to create another layer of meaning and therapy in our healthcare gardens is being overlooked.
Several themes emerged from the interviews, which were intentionally open-ended. One of the most often-heard comments was the need for collaboration between disciplines. Not only hospital or nursing home administrators, but nurses, therapists, and perhaps most importantly, maintenance staff, need to be included in discussions and designs for therapeutic gardens. Landscape architects were criticized for not knowing enough plant species (or in one case, specifying a poisonous oleander in an Alzheimer’s garden); for poor design choices (paving, glare), which led to nurses and patients avoiding a garden due to lack of safety or comfort; or for ignoring the long-term issues of maintenance and funding which led to a garden’s eventual decay. Medical researchers, academics and landscape architects all wished for more concrete research studies that prove in both medical and monetary terms the utility of therapeutic gardens. Unfortunately, time and funding for such studies are rare.
Bees and poisonous plants were other concerns that arose repeatedly. “We need bees,” stated Hazen firmly, and most everyone agreed with her. Mooney, a former beekeeper as well as landscape architecture professor, noted that placement of bee-attracting plants is key: as long as they are not along a path or over a sitting area (and staff have antidotes handy in case of stings), bees have a place in every garden. Wasps and hornets are another story; he suggested avoiding soft-fruited plants that attract them, or placing these plants far from the path of a garden.
Other unexpected topics were revealed as well. Ethnic, economic, and generational differences can make a huge difference in how people perceive gardens. Rosemary, beloved in Mediterranean populations, is associated with death and funerals in many Asian cultures, and was part of the reason an Asian garden in Oregon had to be redesigned. The white picket fences and clotheslines that the elderly clients of Robert Hoover’s Maine gardens loved would seem silly in the high-end retirement home being designed by Catherine Mahan. “The nurses told me, ‘Clotheslines? Honey, these ladies never washed a load of clothes in their life!’” she recounted. And a number of respondents, thinking of the habits of today’s children compared to today’s nursing home residents, wondered what the therapeutic garden of the future would be like. What sort of environment will be preferred by baby boomers, many of whom grew up in suburbs, as compared to elderly of today whose backgrounds include farming and rural settings? Will kids today still want the lilacs and gardenias of Grandma’s garden? As Joanne Westphal asked, “How many people live on farms today?”
The hypothesis of this thesis—that scented plants and building materials could be used to stimulate memory recall and conduct reminiscence therapy—was confirmed by the respondents. The ability of such fragrance-triggered memories to improve quality of life in elderly people became evident through the stories they told: a rose taking an old lady back to the English garden of her childhood, or gardenias reminding elderly Wisconsin women of the high school dances of their youth. These memories have been shown to help elders feel better about their lives, and come to know and appreciate the other residents and staff where they now reside. But when the perfume of a lilac or magnolia blossom brings a rare moment of recognition of a family member, an additional level of therapy is reached: one that helps the loved ones of the older adult cope with the gradual fading away of the person they once knew. As elders and families look for long-term care, homes that address their concerns about mobility, choices, and memory will have an advantage over more traditional “warehouse” style facilities. Landscape architects can deploy plants and materials to revive both the past lives and present spirits of elderly residents of long-term care homes.
This thesis was accepted by the University of Texas at Arlington and published in May 2007. It can be accessed for free or from University of Texas at Arlington's library (also for free).
Wendy Meyer, Associate ASLA, is a 2007 MLA graduate working towards her licensure. She has been working with a small, primarily residential practice for two years, encouraging design with native and adapted plants, rainwater harvesting, and green roofs. She can be reached at: firstname.lastname@example.org.