Healing Spaces: The Science of Place and Well-Being (Overview)

Why does a walk through a sunlit garden feel restorative, while a few hours in a windowless office leaves you drained? In Healing Spaces: The Science of Place and Well-Being, physician and NIH researcher Dr. Esther M. Sternberg reveals that these reactions aren’t just psychological—they’re biological. She explains how our physical surroundings communicate directly with our immune systems. By understanding sensory pathways, we can move beyond mere “efficiency” in architecture to design spaces that actively trigger the body’s natural relaxation response and accelerate recovery.

Keep reading to understand the scientific link among stress, relaxation, and immunity; to learn how modern design often inadvertently sabotages our health; and to discover ways to create spaces that support the mind and body.

Overview of Healing Spaces by Esther M. Sternberg

Have you ever noticed that certain places make you feel calm—a sunlit room with a view of trees, a quiet garden, a familiar space filled with comforting scents—while others leave you anxious and exhausted? These reactions aren’t just in your head. In her 2009 book Healing Spaces: The Science of Place and Well-Being, Esther M. Sternberg draws on decades of research in neuroimmunology, the study of how the brain and immune system communicate, to show that what you see, hear, smell, and experience in your surroundings triggers specific neurological responses that directly affect your immune system. In short, your surroundings can either suppress or enhance the body’s ability to heal.

As a physician and a researcher at the National Institutes of Health (NIH), Sternberg helped establish the scientific foundations of the mind-body connection. Her interest in healing spaces grew from personal experience: After Sternberg developed inflammatory arthritis, she found herself healing during a visit to a village in Crete, where she was surrounded by nature and fragrant gardens. When she returned home, she began to investigate the science behind why certain places promote healing, addressing a critical problem: Modern buildings are often designed for efficiency rather than human well-being, creating environments that impede healing by triggering chronic stress. 

Sternberg contends that, by applying neuroscience to design, we can create spaces—hospitals, workplaces, schools, and homes—that support the body’s healing processes. In this overview of Healing Spaces: The Science of Place and Well-Being, we examine how spaces affect healing by triggering stress or relaxation, and why modern design often works against this natural process. Then, we investigate the sensory pathways through which your environment influences your health, so we can translate the science into design principles for creating spaces that support healing.

How Physical Spaces Influence Healing

The space you’re in right now—whether a cluttered office, a sunlit room, or a windowless basement—is influencing your health. Sternberg writes that physical environments trigger responses in your brain that cascade through your nervous system and immune system and either support or undermine your body’s healing processes. First, you use your senses to perceive features of your environment—the view, the sounds, or how easily you can find your way. Second, these perceptions trigger responses in the regions of your brain that govern stress, emotion, memory, and reward. Third, your brain translates these responses into the release of hormones and chemicals that affect your immune system’s ability to function.

Sterberg explains that, when you’re in a stressful environment—one that’s noisy, confusing, or isolating—your brain releases stress hormones like cortisol and adrenaline. In the short term, these hormones suppress your immune function so you can use your energy and focus to do what’s necessary to survive. If stress becomes chronic, this suppression continues, leaving you vulnerable to illness. When you’re in a calming environment—one with views of the natural world, natural light, and spaces that are easy to navigate—your brain shifts toward what scientists call the relaxation response: Your heart rate slows, your breathing deepens, and your immune system becomes more active. 

Over time, repeated exposure to the stress response leads to measurable differences in how quickly you heal from surgery or illness, how much pain you experience, how many infections you develop, and your overall resilience. To understand exactly how this works, we have to look at the links scientists have discovered between stress, relaxation, and the immune system.

The Biological Link Between Stress and Immunity

Sternberg says that, for most of the 20th century, scientists believed the brain and the immune system operated independently—that the brain governed behavior while the immune system automatically defended against disease without much input from the brain.

Sternberg’s own research helped overturn the assumption that the brain was isolated from the immune system and demonstrated that these two systems are in constant communication with one another. This connection enables stress to suppress immune response, and relaxation to enhance it.

How Stress Suppresses Immunity

When you encounter a stressor, your brain activates the stress response. Sternberg says that the hypothalamus, a region of the brain that helps regulate the autonomic nervous system, releases hormones that trigger a stress cascade—a chain reaction in your endocrine system, which produces and secretes hormones that travel throughout your body. First, the pituitary gland signals the adrenal glands to release cortisol and adrenaline. At the same time, a part of the brainstem called the locus ceruleus releases norepinephrine. Together, these chemicals create the physical experience of stress: racing heart, rapid breathing, heightened alertness, and muscle tension. 

In short bursts, the stress response helps you survive threats by sharpening your focus on your surroundings. But chronic exposure to stress (and the hormones it triggers) prompts your body to prioritize immediate survival over long-term health. This directs resources away from fighting infections or healing wounds and weakens your body’s defenses over time. In particular, heightened levels of cortisol and adrenaline reduce the production and activity of white blood cells (which play a crucial role in fighting infections). They also slow the inflammatory response your body needs for effective wound healing. 

How Relaxation Enhances Immunity

Conversely, when you feel calm and safe, your nervous system shifts to the relaxation response, a process governed by the vagus nerve. This nerve, which carries signals from your brain to organs throughout your body, kickstarts a series of changes: It slows your heart rate, deepens your breathing, signals your immune system to produce antibodies (proteins that recognize and fight pathogens), and supports the activity of immune cells that fight infection. Experiencing positive emotional states—feeling loved, hopeful, or peaceful—triggers the release of endorphins (the brain’s natural painkillers), dopamine (a neurotransmitter associated with reward), and oxytocin (associated with bonding), creating conditions for healing.

Sternberg notes that this bidirectional pathway between your brain and your body—which enables stress and relaxation to affect immunity—means that when the places where you spend your time affect your emotional state, they have measurable effects on your health. Psychologist Roger Ulrich demonstrated this in a 1984 study of patients who’d undergone surgery at a hospital where some rooms had windows overlooking trees while others faced a brick wall. Everything else about these patients’ care was identical: the same surgical team, nurses, and protocols. Patients with views of trees left the hospital almost a full day sooner, required significantly less pain medication, and had fewer post-surgical complications. 

Modern Spaces Work Against Healing

If the environments where we spend our time affect our health, why are so many buildings, especially hospitals, designed in ways that impede healing? Sternberg says the answer lies in how medical knowledge (particularly our understanding of infectious disease) has evolved over the past two centuries. 

For much of human history, hospitals were places where many people died instead of getting better, largely because of uncontrolled infections. After Louis Pasteur’s and Joseph Lister’s work established that germs cause infections, germ theory revolutionized medicine—and hospital design. Late in the 19th century, drawing on new knowledge about how to stop the spread of pathogens, hospitals were built with high ceilings for air circulation, large windows for sunlight, widely spaced beds, easy-to-clean surfaces, plus scenic locations and gardens for patient well-being. 

But Sternberg reports that in the 20th century, the holistic approach narrowed to a single-minded focus on sterility. Architects covered surfaces with materials that could withstand harsh disinfectants: metal, tile, vinyl, and hard plastics. But these materials are acoustically reflective, which made hospitals noisier (and more stressful). Windows shrank or disappeared as architects prioritized space for medical equipment and packed more beds into each area. Today, many health care facilities create precisely the conditions that researchers know suppress immune function: high noise levels, confusing layouts that trigger stress, lack of natural light, absence of nature views, and isolation from social support. 

What Are the Sensory Pathways of Healing?

Now that we understand that place affects healing through the stress-immune connection, we can examine the specific pathways through which this happens and how to design spaces that support these pathways. Sternberg identifies five primary pathways through which your environment affects your health: what you see, what you hear, what you smell and touch, how you navigate, and what you believe and feel. 

Each pathway works through specific biological mechanisms that either trigger stress responses or activate healing responses. Understanding these pathways allows you to design spaces—whether health care facilities, workplaces, or homes—that support health instead of undermining it.

How Light and Scenery Affects Healing

The first pathway is through light and what you see. When you view a natural scene—trees, water, or mountains—visual signals travel from your eyes to the visual cortex and then to the parahippocampal place area, which recognizes scenes. Sternberg writes that along the way, signals activate brain regions that release endorphins, the brain’s natural painkillers. Sternberg notes that certain visual patterns found in nature are especially calming, like fractals: repeating geometric patterns at increasingly smaller scales, like tree branches or snowflakes.

Light regulates your internal clock through a different mechanism. Sternberg explains, that when strong light hits specialized cells in your retina, these cells signal the suprachiasmatic nucleus (SCN), a brain region that controls circadian rhythms. This region uses light signals to regulate your levels of cortisol (which peaks in the morning to promote alertness) and melatonin (which rises in the evening to promote sleep). When your exposure to natural light is disrupted—for example, by spending a lot of time in windowless spaces or under fluorescent lighting—the levels and timing of these hormones become dysregulated, which can lead to depression, trouble sleeping, and weakened immunity.

What This Means for Design

Sternberg recommends that health care facilities maximize patients’ access to natural views and natural light. Windows should face gardens or trees rather than walls. She points out that hospitalized depression patients in sunny, east-facing rooms (which receive morning light) recover several days faster than those in dimly lit rooms. For patients without window access, nature photography can provide some benefit. In spaces where natural light is limited, full-spectrum lighting that mimics sunlight can help regulate circadian rhythms. Spaces can also incorporate fractal patterns through artwork or architectural details.

At home, Sternberg recommends positioning work areas near windows, using plants to bring natural visual patterns indoors, and ensuring that you get plenty of bright light exposure in the morning to support healthy sleep-wake cycles.

How Sound Affects Stress and Relaxation

The second pathway through which your environment affects your health is sound. Sternberg explains that the sounds you’re exposed to affect your stress levels based on whether they’re sudden and unpredictable or monotonous and soothing. Unexpected noises trigger the startle response, an involuntary reaction to sudden sounds, sending signals to your amygdala (the brain’s fear center). This activates the stress cascade—the chain reaction of hormone releases we discussed earlier—and causes your adrenal glands to release cortisol and adrenaline. On the other hand, when sounds are monotonous—like rain or ocean waves—your brain gets used to the sound and stops actively responding to it, promoting a sense of calm and relaxation.

Music works differently than other types of sound. Sternberg writes that, when you hear emotionally moving music, auditory signals travel to the nucleus accumbens, a brain region that releases dopamine and endorphins, activating the same pain-relief systems as viewing natural scenes. Research shows music can reduce the amount of pain medication that patients need by 15-20%, and by as much as one-third to one-half in some surgical contexts.

What This Means for Design

Many buildings create stressful sound environments. Hospital intensive care units regularly reach 98 decibels—comparable to the noise level of a motorcycle—triggering the startle response repeatedly and keeping stress hormones chronically elevated. Sternberg recommends incorporating sound-absorbing materials to reduce ambient noise. Studies have shown this has an effect on patients’ healing: When Swedish researchers replaced sound-reflecting ceiling tiles with sound-absorbing ones in a coronary care unit, their patients showed improved outcomes with fewer rehospitalizations.

Sternberg also recommends that spaces should minimize sudden, unpredictable noises by reducing alarm volumes and separating noisy equipment from patient areas. Conversely, design can incorporate beneficial sounds by providing access to nature recordings or music therapy programs. At home, Sternberg suggests using white noise or nature sounds to mask disruptive noises and incorporating music into daily routines for stress reduction.

How Scent and Touch Connect to Emotion and Memory

The third pathway involves scent and touch, which create particularly direct connections to emotion and memory. Sternberg writes that when odor molecules enter your nose, they bind to olfactory nerve cells that extend directly into your brain and connect to the hippocampus (which processes memory) and the amygdala (which processes emotion). This is why scents instantly evoke memories and feelings. When you smell something associated with positive memories, those pathways activate and trigger the release of calming neurochemicals.

Touch from loved ones activates a bonding pathway. According to Sternberg, signals from touch-sensitive nerves in your skin trigger the release of oxytocin, which travels through your bloodstream and reduces cortisol, enhances immune cell activity, and promotes bonding and trust. Studies show that premature infants who received regular massage gained weight faster and showed increased vagus nerve activity, while socially isolated adults showed elevated stress hormones and slower wound healing.

What This Means for Design

Sternberg suggests that health care facilities should allow patients to personalize spaces with familiar scents that evoke positive memories—perhaps through fragranced sachets or with their preferred personal care products. Some hospitals incorporate aromatherapy programs using essential oils, though people’s responses to specific scents vary based on individual associations.

Design should also facilitate touch and physical connection. Sternberg argues that health care facilities should create private spaces where families can comfortably spend time with patients and that health care providers should encourage practices like infant massage in neonatal units. Policies restricting family members’ presence in rooms with their loved ones should be reconsidered where medically feasible, given the measurable health benefits of social connection. At home, Sternberg recommends surrounding yourself with scents that make you feel calm and prioritizing physical affection within trusted relationships.

How Navigation and Spatial Clarity Reduce Stress

The fourth pathway works through spatial navigation and your sense of place. Sternberg asserts that how you navigate space affects stress through uncertainty. When you can’t see your destination and must make repeated decisions about which way to turn, each choice activates your stress response. The hippocampus, your brain’s spatial navigation center, contains “place cells” that integrate sensory signals to tell you where you are. When navigation is clear, your hippocampus processes spatial information efficiently. When navigation is confusing, your hippocampus struggles to create a coherent map, which your brain interprets as a threat.

Conversely, predictable movement through a space that’s easy to navigate, like walking a labyrinth, promotes calm by eliminating uncertainty. (A labyrinth differs from a maze: A labyrinth has a single winding path to the center and back out, while a maze has multiple paths with dead ends and decision points.) Sternberg writes that walking a labyrinth at a steady pace regulates breathing into a slow pattern that activates the vagus nerve, which signals your heart to slow down and your adrenal glands to reduce cortisol production.

What This Means for Design

Many buildings, especially hospitals, function like mazes with complex layouts, long corridors, and few distinguishing features to help you find your way. When patients navigate these spaces while already anxious about their health, their stress increases at the very moment when lower stress levels would support healing. Sternberg argues that facilities should be designed with clear sightlines, distinctive landmarks, and intuitive layouts. This includes consistent signage, visual markers at decision points, and clear views to destinations. Some hospitals serving patients with dementia have adopted “Main Street” designs with familiar features like storefronts that help people navigate despite memory impairments.

Sternberg also suggests that the design of the places we spend our time—workplaces, public spaces, and residential spaces—can incorporate walking paths. Many hospitals offer paths to patients, families, and staff for stress reduction. At home or in workplaces, Sternberg recommends creating clear, intuitive organization and incorporating opportunities for regular walking to gain the stress-reduction benefits of predictable, rhythmic movement.

How Expectation, Belief, and Connection Amplify Healing

The fifth and perhaps most powerful pathway involves expectation, belief, and social connection. Sternberg contends that expectation and belief can trigger the same neurochemical releases as direct sensory experiences. When patients believe they’re receiving treatment, that belief activates brain pathways that trigger healing chemicals. Patients who thought they were receiving morphine but got a saline solution instead experienced pain reduction because their expectations activated neurons that released endorphins. According to Sternberg, powerful emotions—hope, faith, compassion, and love—intensify these effects.

Social support amplifies your body’s healing responses by triggering the release of oxytocin, which reduces stress hormones and enhances immune function. Sternberg examines Lourdes, a French pilgrimage site where, since the 1850s, millions of people have traveled seeking healing after a young girl reported visions of the Virgin Mary there. The Catholic Church has investigated reported cures and verified 67 as medically unexplainable healings. These documented healings share a pattern: They occur when patients experience profound warmth, peace, and love. Sternberg argues that places like Lourdes provide positive expectation (hope that healing is possible) and social support (acceptance within a caring community).

What This Means for Design

Sternberg argues that the most effective healing spaces combine positive sensory features with elements that foster hope, meaning, and connection. Health care facilities should create welcoming environments that signal care and possibility rather than institutional processing. This includes spaces for families to gather comfortably, private areas for intimate connections, and environments that feel more like homes than institutions—using warm colors, comfortable furnishings, and layouts that facilitate social interaction.

Sternberg suggests that facilities can incorporate spaces that support spiritual and contemplative practices—chapels, meditation rooms, gardens, labyrinths—acknowledging that belief, expectation, and emotional experience activate real biological pathways. Policies should support rather than restrict family presence and social connection, given the measurable effects on healing outcomes.

Beyond health care, Sternberg argues that these principles apply wherever people spend significant time. Workplaces that foster connection, homes that serve as gathering places for loved ones, and communities that provide social infrastructure all support healing by activating oxytocin pathways and buffering stress. At an individual level, Sternberg suggests cultivating hope and positive expectations about your ability to heal, maintaining strong social connections, and creating rituals that evoke feelings of meaning, peace, and connection.