Distinction and Multiplicity

DISTINCTION AND MULTIPLICITY Maggie’s centres and the future of urban care

MURIEL MULIER ESSAY FOR POSTGRAD HOUSING & URBANISM COURSE: CRITICAL URBANISM TERM 1 2019 TUTOR: LAWRENCE BARTH

MURIEL MULIER

DISTINCTION AND MULTIPLICITY

ABSTRACT Cities in space and time are challenged to be both distinct and multiple.

Colin Rowe’s collage technique is taken as a starting point to discuss multiplication and distinction in the city. Throughout the essay, we will apply Rowe’s argument on the case of the care landscape.

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Multiplication might lead to a generic city. The scorn and disvalue of this are discussed through Rem Koolhaas’s argument on provisional freedom. On the other hand, the distinction can lead to a very special definition. Charles Jencks positions Maggie’s centres in between strong and weak determinism. At first sight, Maggie’s centres as part of the ‘hospice movement’ are architectural jewels, yet they are values for much more and they are rapidly changing our future notion of care in urbanity.

Distinctiveness becomes richer when it has in itself multiplicity, it is almost outrunning the multiplicity. They both can be part of the collage of the city. In specific, Maggie’s centres can become a vaster value in the future of our urban care.

INTRODUCTION

1 Charles Jencks and Edwin Heathcote, The architecture of hope : Maggie’s cancer caring centres,(London: Frances Lincoln, 2010), p. 54.

4 Hashim Sarkis, Timothy Hyde and Pablo Allard, Le Corbusier’s Venice Hospital and the Mat Building revival, (London: CASE, 2001), p. 186.

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Let’s first acknowledge that our cities are working ‘modern hospital’ was dislocated outside the as an amalgam of different systems. These city walls. This explains a bigger shift in many systems are not always integrated and frequently European cities, from the hospital as a cipher fragmented in space and time, yet they are all for benevolence and charity towards a modern contributing to the city as a whole. In the case machine of efficiency and hygiene. “The new of our care landscape, we notice that this is hospital was a monument to hygiene and the expressed in multiple loci and that it changes notion of a standard of modern healthcare throughout all seasons. Health care is a system available for all.”2 with multiple facets, it mostly starts with your local general practitioner in a community centre until the specialist in a big health institution. We The multiplication of possibilities in health can argue that there are two poles in the city; care institutions leads to an increase in the distinction and multiplicity. complexity of a hospital institution brief. For example, many subunits request independence and integration at the same time. Constantly, The position of a care system in the city used to the dynamics of health care are challenged by be pivotal and as a consequence, left significant innovation and this leads towards continuous imprints on the fabric of the city. Edwin Heathcote, adaptations.3 an English architect and designer, highlights that For example, the last unbuilt project of Le the health system used to be positioned in the Corbusier, the Venice hospital, proposed a middle of the city, showing an important image of new flexible ‘mat’ type hospital that could mercy and charity for the city metropolis.1 grow based on the particular needs. 4 The If we would look at the St. Bartholomew Hospital field of hospital design is an exercise between in London founded in 1123 for example, we see economic efficiency versus a human process that it remains until today an epitome of an urban of continuous adaptation to the latest scientific hospital. Its location in the city fabric remains knowledge. solidly embedded in the everyday life of the metropolis. It has research centres, educational institutions and health trusts, but also advice Firstly, in this essay we will take the collage councils, mother and child care all in the direct technique of Colin Rowe as a starting point to environment linked to the hospital. The hospital discuss multiplication and distinction in the city. itself was originally only a hospitalisation unit and We will discuss most importantly the arguments needed to add emergency and ambulatory care in of Rem Koolhaas and Charles Jencks on the the existing buildings. Moreover, new structures generic and architectural determinism. are needed outside the existing buildings, for This essay is throughout applying these instance, diagnostic centres for radiology. This arguments to our notion of health care in the evolution is quite unique, considering the trend city specifically. Further, I will highlight the of many hospitals to dislocated from their old emergence of distinctive new practises such hospital site intra muros to a new and bigger site as Maggie’s centres and will look into their extra muros. This was the case in the Flemish relationship to the city. city of Bruges. Saint John’s Hospice, dating back Ibidem, p. 77. from the same period, founded in 1150, provided 2 3 Cor Wagenaar and Noor Mens, Health Care during Medieval times care for pilgrims, travellers architecture in the Netherlands, (Rotterdam: NAi-publishers, and the poor. In the 70s, a full new and larger 2010) p. 226.

MURIEL MULIER

A COLLAGE OF DISTINCTION AND MULTIPLICATION

This is an argument in favour of a co-existence of both distinction and multiplicity.

In our cities we can have both the purism and the pluralism, Rowe is thinking through ambiguity. He states: “The job is that of making the city safe by large infusions of metaphors, analogical thinking, ambiguity; in the face of prevailing scientism and conspicuous laissezaller, it is just possible that these activities could provide the true survival through design.”7

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The technique of a collage by Colin Rowe helps us think of the fragments of the city when at the same time you don’t need to accept the total picture.5 Rowe argues in his final chapter ‘the collage city and the reconquest of time’ that there are two mind-sets. There is one that wants reachable and concrete facts. This party needs the support of definition. Another state of mind is based on facts that are more fugitive, they will never be further specified. This party needs the support for illumination of interpretation. 6 For example, the established Gartnavel General Hospital of Glasgow is located right next to the distinctive Maggie centre designed by Koolhaas.

Figure 1: The collage of distinctiveness with the Maggie centre designed by OMA and multiplicity of the Gartnavel Hospital as an established machine.

When Rowe mentions the two completely opposite ideas of the domestic mind of the engineer and the savage mind of the ‘bricoleur’, he argues that for an architect (or artist) these minds should not be seen separate. The architect can both be something of a bricoleur and something of a scientist at times. They can co-exist and are complementary.

5 Colin Rowe and Fred Koetter, Collage City, (London: The MIT Press, 1978) p. 149.

6 Ibidem, p. 119-120.

When he refers to the grid in New York City, he draws attention to the fact that the grid is offering a highly energetic scaffold for any fluctuating casual event. The architect is biased when he would think of the city as a total design. He concludes that the ideal city depends on the complexity of its parts. Rem Koolhaas highlights the same multiplication that is possible with the skyscraper in Delirious New York. As a consequence, the reproduction of the 7 Colin Rowe and Fred Koetter, Collage City, (London: The MIT Press, 1978) p. 117.

world in a single plot of the grid: “(…) means that a particular site can no longer be matched with any single predetermined purpose. From now on each metropolitan lot accommodates - in theory at leastan unforeseeable and unstable combination of simultaneous activities, which makes architecture less an act of foresight than before and planning an act of only limited prediction. It has become impossible to “plot” culture.” 8

TOWARDS A GENERIC CITY?

Back to our case study of the care landscape, we notice that because caring is something you can give and receive in all sorts of forms, a range of possibilities of caring is welcome in our society.

Mega hospitals can have a maximum of event structures that can stimulate and benefit from each other. For example, think of the St. Bartholomew hospital close to amenities of education and research. An event structure is the result of the tactic of disestablishment Koolhaas is using in his architecture, explains Jeffrey Kipnis in his chapter on Recent Koolhaas. 9 Disestablishment defines something that is derived of its established status.

Taken this term very literally, this would mean the closure of the institution. Not to confuse with the definition of deinstitutionalisation. For example, deinstitutionalisation is a process of replacing long-stay psychiatric hospitals with less isolated community mental health services.

With this tactic, Kipnis points out how a program can generate an event structure incongruent with the program. He defines event structures as “ (…) structure(s) to indicate all social activities and chance events, desirable or not , that architectural setting stages and conditions. These included but are not limited to the expressed activities of the program of the space.”10 If your program is strongly in line with what was expected to be, it becomes an extreme convergence, something that is tolerable in institutions like prisons or hospitals.

Yet it could be undesirable for the domestic environment.

We can make the following two opposite conclusions on disestablishment. Firstly, extreme convergence makes our cities generic, and the disestablishment of the institution makes from the hospital, for instance, nothing more than a secure organisation of flows, a number of beds and an unaddressed waiting Kipnis mentions Koolhaas’ focus on area in-between. One could argue this makes disestablishment of a liberating technique. For it not different from an airport. Kipnis asks if Koolhaas architecture can provide provisional disestablishment is not a profound threat to the freedoms in a defined situation, such as multiple discipline of architecture as we know it today.11

8 Rem Koolhaas, Delirious New York: a retroactive manifesto for Manhattan, Edition 2014, (New York: Monacelli Press, 1994), p.86.

9 Jeffrey Kipnis, A question of qualities: essays in architecture, chapter 5, Recent Koolhaas, (Cambridge: The MIT Press, 2013) p.115-145.

10 11

Ibidem, p. 127.

Ibidem, p. 144.

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As a result of multiplication, our cities are becoming generic. Rowe discusses that the effort of the architect to fit in a grid is institutionalising programs in their designated plot.

experiences and sensations. Koolhaas demonstrates that these liberating, tangible experiences can rise even in a restrictive context. Even if Koolhaas has never written a consistent catalogue or manifesto on freedom and architecture, Koolhaas’s technique lies in his handling of the brief. For the project of the Bibliothèque National in Paris, he brings the brief back to the essence and he copes with the weight of the institutional presence. It’s no longer the classic library, where you only come to borrow books and read, exactly by this reduction of the project the result is barely recognizable as a library from a semiotic or typological standpoint.

MURIEL MULIER

On the contrary, there is also an argument in favour of the generic city. Kipnis explains that the so-called infrastructionalists, the architects that want a maximum of event structure12, see the value in a cross-over of generic architecture.

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TOWARDS A DISTINCTIVE CITY? MAGGIE’S CENTRES.

The other pole in our city is the emergence of new practises that are distinctive. The range of different approaches towards care in the city fabric becomes wider. We have specific moments in our lives, from birth to death where we are in need of a qualitative and caring environment. The focus on our individual well-being becomes more important, when patients are dealing with mortality, it is likely considered as a personal experience.

Maggie’s centres are part of a moving trend called the ‘hospice movement’. They are examples of the distinctive emergence of new practises in the care landscape.

12 Jeffrey Kipnis, A question of qualities: essays in architecture, chapter 5, Recent Koolhaas, (Cambridge: The MIT Press, 2013) p.145.

Maggie’s centres are a network of drop-in centres, founded in the UK by wife and husband Maggie Keswick and Charles Jencks that tries to achieve a warm and encouraging place for anyone who has been affected by cancer. A Maggie centre puts the patient in the centre of a unique setting.13 It is a place for personal and collective definition, one of the mind-sets Colin Rowe was describing as mentioned earlier.

Today twenty-two Maggie’s centres have been built by renowned architects such as Daniel Libeskind, Benedetta Tagliabue, Steven Holl and Frank Gehry. Each of these cancer care centres is very distinctive, see figure 2, there is no such thing as a model for Maggie’s centres.

Figure 2: Comparative plans drawn by Lily Jencks. The difference in formal types from pinwheels to donuts makes them hybrid. The circulation shows the pivoting role of the open kitchen. There is a sharp contrast between contained and open space. And finally,

the series on the bottom shows the importance of a fluid open space towards the exterior, as Frank Lloyd Wright.

13 Ken Worpole, Modern Hospice Design, The architecture of palliative care, (Abingdon: Routledge, 2009), p. 7.

the design of hospitals, highlights the common opinion that hospitals are built as anonymous institutional complexes and that because of their ill-working architecture they are unfit to make people feel at home and he goes even further, these institutions can possibly kill people.17 This radical tradition that puts tremendous emphasis on the cultivation of our individual distinctiveness makes freedom of the individual as a personal project. Ivan Illich, who is against all institutions, is most exemplary for this. In his book Medical Nemesis, he claims that the individual is always under threat because of the role of the institution.

He states, that in every major field of human endeavour, there are two types of production: the autonomous and the heteronomous. The One opinion, a bit short-minded in my point of view, autonomous mode is about the individual, what might be that they are like jewels, little icons and can he discover through production on his work of art with a ‘starchitecture allure’. I would own? The heteronomous mode is one where argue they are much more than that. They are the planner lies the priority for the big group of praised for their poetics of space, their ethos of people first. Every society will depend upon the care that is central in the design instead of the synergy of both, says Illich. The real treat lies in beauty of the plan. Maggie’s centres have a specific the institutions, they are only effective on the brief that asks for ‘kitchen table domesticity’. It industrial heteronomous side. People’s ability is built only for a small group of approximate 12 to defend themselves is declining. Society people. There needs to be a large sitting room, is rearranging productiveness. We need a sheltered spaces and the connection with a synergy of both personal doing and institution garden is vital. Yet, are cosiness and domesticity making, the unbalance of this gives negative enough? The centres show how a group and returns. This is coming to misery of a new kind, ambience can support a central message of an Illich concludes.18 organization. The variety in which it does this is You could argue that as special as they are, surprising, it is clear that with 250 kinds of cancers, distinctiveness becomes richer when it has there is no right approach towards a cancer caring in itself multiplicity, it is almost outrunning centre. “Maggie’s centres are necessarily complex the multiplicity. With the case of the Maggie’ in metaphor and form.”16 centres I try to show that this was initially an This modern hospice movement can be seen alternative mode of care and it is interesting as a part of the resistance against growing to think about how they could evolve towards medicalization. Cor Wagenaar, Dutch historian on a vaster value in the future.

14 Ken Worpole, Modern Hospice Design, The architecture of palliative care, (Abingdon: Routledge, 2009), p. 10.

15 Charles Jencks and Edwin Heathcote, The architecture of hope : Maggie’s cancer caring centres,(London: Frances Lincoln, 2010), p. 39.

16 Ibidem, p. 41.

17 Ken Worpole, Modern Hospice Design, The architecture of palliative care, (Abingdon: Routledge, 2009), p. 4.

18 AA School of Architecture, Ivan Illich - Medical Nemesis: The Expropriation of Health lecture in 1974, online video recording, YouTube, 8 August 2017, <https:// www.youtube.com/watch?v=kAO7_9qACIs> [accessed 3 December 2019].

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The Maggie’s centres are successful, Ken Worpole describes them as: “It is the work of architecture at such times and in such places that can inspire and provide solace, even if it cannot heal.” 14 Charles Jencks himself is doubtful what the effect of the centres have on health and its survival, this is undecidable. Jencks uses the concepts of SAD (strong architectural determination) and WAD (weak architectural determinism). On the one hand, he does not want them to be SAD, where architecture is completely shaping you. On the other hand, he does not want them to be WAD, where it does not matter if they are beautiful or ugly. No, his conclusion is that Maggie’s should be in between. He said he values them because they give an alternative, definition of space in the urban environment.15

MURIEL MULIER

CONCLUSION

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If we acknowledge the trend of new practises in the care system, we see different approaches to the built fabric. The urban area can be seen as care and well-being environments. At present, Maggieâ&#x20AC;&#x2122;s centres are buildings, with a strong care environment on the inside, but not really taking a wider urban notion on the outside. There is the aspect of the close relationship with nature, something that can, of course, be developed more in rural than urban areas, but this takes an interesting leap towards the search of a wider connection.

In the future, they could become more interwoven with their urban condition. The advantages and disadvantages of the location, summed up by Ken Worpole, see figure 3, can be a first step in formulating evaluation criteria for Maggieâ&#x20AC;&#x2122;s centres in the future.

Through the ambiguity, Rowe describes we can conclude that both distinction and multiplicity are two parts of the collage of the city. Questions can be raised about how the hospital of the future should look like? Further research through design could tackle this question. Firstly, starting from the conclusion that the hospital as an institution becomes more connected and open towards the civic realm. Secondly, that the balance of both distinctiveness and multiplicity can co-exist in the city. Is the hospital of the future even a building? Is it not more a condition, like the city, always changing in time and space?

Figure 3: The advantages and disadvantages of an inner-city or rural location of existing and new hospice sites.

BIBLIOGRAPHY References: AA School of Architecture, Ivan Illich - Medical Nemesis:

Illich, Ivan, Deschooling society, Edition 2002, (London: Calder and Boyards Ltd, 1971).

The Expropriation of Health lecture in 1974, online video recording, YouTube, 8 August 2017, <https://www.youtube.com/ watch?v=kAO7_9qACIs> [accessed 3 December 2019].

Jencks, Charles and Heathcote, Edwin, The architecture of hope: Maggie’s cancer caring centres, (London: Frances Lincoln, 2010).

Charles Jencks and Edwin Heathcote, The architecture of hope : Maggie’s cancer caring centres,(London: Frances Lincoln, 2010).

Kipnis, Jeffrey, A question of qualities: essays in architecture, chapter 5, Recent Koolhaas, (Cambridge: The MIT Press, 2013)

Colin Rowe and Fred Koetter, Collage City, (London: The MIT Press,

p.115-145.

1978).

Koolhaas, Rem, Delirious New York: a retroactive manifesto for Cor Wagenaar and Noor Mens, Health Care architecture in the

Manhattan, Edition 2014, (New York: Monacelli Press, 1994).

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Netherlands, (Rotterdam: NAi-publishers, 2010).

Rowe, Colin, Koetter, Fred, Collage City, (London: The MIT Hashim Sarkis, Timothy Hyde and Pablo Allard, Le Corbusier’s

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Venice Hospital and the Mat Building revival, (London: CASE, 2001).

Sarkis, Hashim, Hyde, Timothy and Allard, Pablo, Le Corbusier’s Jeffrey Kipnis, A question of qualities: essays in architecture, chapter 5, Recent Koolhaas, (Cambridge: The MIT Press, 2013)

Venice Hospital and the Mat Building revival, (London: CASE, 2001).

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Stolwijk, Willem Quirinus, Flexibiliteit in Ziekenhuisbouw, (Delft: Ken Worpole, Modern Hospice Design, The architecture of palliative

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care, (Abingdon: Routledge, 2009).

Wagenaar, Cor and Mens, Noor, Health Care architecture in Rem Koolhaas, Delirious New York: a retroactive manifesto for

the Netherlands, (Rotterdam: NAi-publishers, 2010).

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palliative care, (Abingdon: Routledge, 2009).

AA School of Architecture, Ivan Illich - Medical Nemesis: The Expropriation of Health lecture in 1974, online video recording, YouTube, 8 August 2017, <https://www.youtube.com/ watch?v=kAO7_9qACIs> [accessed 3 December 2019].

Figures: Figure 1: Sattelite picture of the Maggie centre site in Glasgow (2019). Using: Apple Maps.

Figure 2: Charles Jencks and Edwin Heathcote, The architecture

Groves, Kursty and Marlow, Oliver, Spaces for innovation, the design

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Figure 3: Ken Worpole, Modern Hospice Design, The architecture of palliative care, (Abingdon: Routledge, 2009), p.48.