PDF Summary:Healing Spaces, by Esther M. Sternberg

Why do some spaces make you feel calm while others leave you anxious and exhausted? Physician and neuroimmunologist Esther M. Sternberg reveals that these effects aren’t just psychological: The places where you spend time trigger neurological responses that directly affect your immune system’s ability to heal. In Healing Spaces, Sternberg explains the biological pathways connecting what you see, hear, smell, and experience to measurable health outcomes like recovery speed, pain levels, and infection rates.

In this guide, we’ll unpack the science behind healing environments and translate it into practical strategies you can apply immediately—whether you’re designing a home office, choosing where to live, or simply trying to reduce daily stress. We’ll also explore why people’s responses to healing environments vary based on personality and experience. We’ll dive into the neuroscience behind social connection and ritual, and highlight practical things you can do to reduce stress in a way that works specifically for you.

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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.

(Shortform note: The parahippocampal place area Sternberg mentions is actually part of a larger network involved in processing context, memory, and spatial information. The hippocampus encodes memories of what you experience in a place each time you’re there, so when you view a natural scene, your brain may be activating calming memories and associations. If endorphin release depends partly on memory, the calming effect of nature might be stronger if the scene is familiar: Research shows that recognizing a significant place strongly activates the parahippocampal place area and the amygdala, which processes emotion.)

Why Are Fractals So Calming?

Sternberg observes that fractal patterns—repeating geometric shapes at different scales, like tree branches or snowflakes—are especially calming. As Florence Williams reports in The Nature Fix, physicist Richard Taylor proposes an explanation: Your visual system processes information in fractal patterns, first by taking in scenes with large “sweeps” and progressing to smaller sweeps that follow similar shapes. When you view mid-range fractals (those with a measure of complexity similar to those in natural scenes), your eyes’ scanning pattern matches the structure of what you’re seeing, creating what Taylor calls “physiological resonance” that reduces stress by 60%.

Researchers have also found that the brain and its activity are organized fractally—from individual dendritic trees to whole-brain networks. This raises a question: Does the match between fractals in nature, our visual processing, and in our brains simply reflect that all are made of organic matter, which tends to organize fractally? Or does it suggest that the brain has evolved to efficiently process the fractal patterns common in natural environments?

Light regulates your internal clock through a different mechanism. Sternberg notes 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.

(Shortform note: Research shows that your SCN is more than a simple light detector: It contains 10,000 neurons that each function as a clock. During the day, they communicate via chemical signals to stay synchronized, but at night, neuronal communication shuts down and support cells called astrocytes step in to keep the 10,000 clocks from drifting apart. Then each morning, communication resumes, and the neurons resynchronize. This ongoing process of disassembly and reassembly may explain why disrupted light exposure can so easily throw off your circadian rhythms and lead to the problems Sternberg describes: Your SCN needs consistent light cues to successfully reassemble its communication networks and synchronize its clocks each day.)

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.

(Shortform note: Fractal patterns appear in sacred architecture across several spiritual traditions: Islamic architecture, particularly from the Mameluke period, incorporates fractals at every scale, while French Gothic cathedrals feature these patterns in exterior facades and interior structural elements. Medieval architects intuitively applied these principles centuries before modern mathematics formalized them. Research suggests that buildings with more fractal complexity capture more unconscious visual attention in the first few seconds of seeing them. This suggests that the patterns in mosques and cathedrals don’t just reflect spiritual symbolism—they create spaces that naturally engage our attention.)

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.

(Shortform note: Sunlight regulates your sleep-wake cycles, but your brain doesn’t just differentiate between day and night: It also tracks the seasons. Your SCN senses how rapidly daylength changes to adjust both when and how long melatonin is secreted at night. South-facing windows, which are also favored by the plants Sternberg recommends bringing inside, receive consistent natural light year-round and let you see the sun’s changing angle and path. Your brain uses these cues to adjust its activity: Attention-related activity peaks in summer, and memory-related activity peaks in fall. Yet cognitive performance stays constant—your brain simply adjusts which resources it uses to function efficiently.)

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.

(Shortform note: For people in the 10-40% of the population with noise sensitivity, Sternberg’s principles about sound habituation may not apply. Noise-sensitive people’s brains show heightened activity in response to all kinds of sounds—not just sudden, threatening ones—and they struggle to filter out unimportant auditory information. This means their brains don’t habituate to repetitive sounds the way most people’s do, and even sounds other people find calming might generate excessive neural activity. As a result, noise-sensitive people can experience chronic activation of their stress response, even when they’re exposed to sounds that would quickly become familiar and promote relaxation and calm in others.)

Music works differently than other types of sound. Sternberg notes 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.

Listening to Music You Like Matters Most

Consistent with Sternberg’s emphasis on emotionally moving music, research suggests music helps people to regulate their emotions about pain rather than just distracting them from it.

Studies reveal that music primarily reduces how unpleasant our pain feels rather than its intensity. This effect may work through mechanisms similar to meditation: Both music and meditation reduce the tendency to attach your sense of self to your pain, and they create a brain state less primed for suffering even before pain arrives. What matters most in whether music helps with pain is whether you genuinely enjoy the music, not whether you think it will help—and genre doesn’t matter at all as long as it matches your preferences.

Personal preference is also more important than genre in music’s ability to reduce stress. The nucleus accumbens doesn’t just respond to music you already love—it responds when new music exceeds your expectations. As you listen, your brain predicts what will happen next based on your past musical experience (so classical fans have different expectations than punk devotees). When the music turns out better than predicted—a surprising harmony, an unexpected resolution—the nucleus accumbens fires, releasing dopamine and creating a pleasurable “positive prediction error.” This response is what reduces stress, which means the effect depends entirely on your musical background and preferences.

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.

Complete Silence Can Also Feel Threatening

While Sternberg points out how startling noises and loud environments trigger chronic stress, research suggests that an environment that’s too quiet can be just as unsettling as one that’s too loud. From an evolutionary standpoint, hearing functions as our alarm sense. In nature, when animals go quiet, it usually signals danger, so your brain interprets the absence of sound as a potential threat. Studies show that trying to hear in absolute silence activates the auditory cortex as strongly as processing actual sound does: The brain essentially goes on alert, searching for information that should be there.

This context also demonstrates why gentle, predictable background noise—like rain, a refrigerator’s hum, café chatter, or the nature recordings and music Sternberg recommends—can feel comforting rather than stressful. Some people perceive steady, ambient sound as a sort of “emotional scaffolding” that signals safety to your nervous system. The key distinction is predictability: Your brain can habituate to monotonous sounds and stop actively processing them, whereas sudden, unpredictable, or changing noises repeatedly grab your attention and trigger stress. The key seems to be eliminating disruptive unpredictability while maintaining the baseline of ambient sound that helps your brain feel secure.

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.

(Shortform note: Scent’s unique power to evoke memories stems from how memories are stored in the brain. Each memory is distributed across the areas that experienced it: sights in visual regions, sounds in auditory regions, and smells in olfactory regions. Activating any one of these can trigger the entire network and bring back the complete memory. But what makes scent particularly powerful is its direct anatomical pathway: Unlike vision or hearing, which must pass through the thalamus for processing, scent signals travel directly from the olfactory bulb to the hippocampus and amygdala. This means you often feel an emotional response to a smell before consciously remembering why, a phenomenon researchers call “emotional primacy.”)

Touch from loved ones activates a bonding pathway. Sternberg notes that 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.

(Shortform note: The process Sternberg describes isn’t automatic. Your prefrontal cortex evaluates the social meaning of touch before determining whether to release bonding hormones or activate defensive responses. When your brain registers pleasant social touch, your prefrontal cortex triggers the release of oxytocin and encourages you to move closer to the person. When it registers an unpleasant touch—even when it isn’t painful—your prefrontal cortex activates the brain’s motor planning areas that prepare you to pull away or leave. This evaluation happens rapidly and incorporates contextual information: who is touching you, your recent social interactions with them, and where on your body the touch occurs.)

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.

(Shortform note: Scent associations are personal and changeable. What smells pleasant to you depends on your history of associations, and a single experience with a scent can update that association. When your brain processes a smell, it seems to combine the scent with your internal state at that moment—your mood, hunger level, stress, etc.—so “lavender while relaxed” might register as a completely different smell than “lavender while anxious.” Plus, while the chemical structure of a scent influences how pleasant most people find it, preference accounts for far more of the variation. This creates a practical challenge: A scent that triggers positive associations for one person might trigger negative ones for someone else.)

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.

When Patients Can’t Speak, But Are Listening

Touch and communication from loved ones may be especially important for patients who can’t speak, including infants and people who are unconscious. Patients who recovered after periods of appearing unconscious report remembering things said during that time. Research shows many of these patients are listening and trying to respond, even when they appear unaware. Studies show that 15-20% of patients who appear unconscious actually have “covert consciousness”—their brains understand what’s happening around them, but their bodies can’t respond. AI can now detect their attempts to interact, identifying attempts to open their eyes or move their mouth days before doctors can see such tiny movements.

Patients who can’t communicate verbally with their caregivers can benefit from the effects of touch Sternberg cites. Studies show that premature infants who receive touch gain weight more quickly, show stronger immune function, and engage in more interaction and intimacy with their parents. Similarly, brain injury patients who receive sensory stimulation from loved ones—including touch, familiar voices, and music—show higher consciousness levels and lower pain scores. This suggests that physical and verbal interactions with patients who appear unresponsive may not only support healing but can also encourage patients’ attempts to communicate.

How Navigation and Spatial Clarity Reduce Stress

The fourth pathway works through spatial navigation and your sense of place. Sternberg notes 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.

Why Getting Lost Feels So Terrifying

Navigating an unfamiliar location activates areas of the brain involved in focus and perception, as well as parts of the hippocampus tuned to exploring new locations. Neuroscientists have found that the hippocampus assesses your familiarity with a space on a gradient: One end contains cells that fire when you’re in familiar areas, while the other end responds to new locations, with a continuum in between. Your brain constantly calibrates how well it thinks you know a space, and when the familiarity signal drops too low—when you can’t match what you’re seeing to your mental map, as Sternberg notes—it triggers an intense fear response.

This fear response evolved for a reason: For our ancestors, remaining in unfamiliar territory meant vulnerability to predators, so a strong urge to escape motivated them to find their way back to safety quickly. The problem is that in modern contexts, this fear escalates into full panic that overwhelms your ability to think clearly, which can be particularly disorienting when you’re navigating without landmarks and your “mental compass” starts to drift. Ninety percent of lost people compound their problems by running or wandering instead of staying put because their panic prevents them from making strategic decisions. The fear that should drive purposeful problem-solving instead shuts down the reasoning they need to find their way.

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 notes 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.

(Shortform note: While Sternberg writes that labyrinths reduce stress by eliminating uncertainty, research suggests the ancient practice of walking a labyrinth initially creates physiological arousal that resolves into relaxation. The labyrinth creates a paradoxical space: You’re physically safe but mentally disoriented, which allows you to work through thoughts and emotions symbolically as you walk. The biological mechanism underlying the shift from arousal to calm involves the vagus nerve, which has a stronger influence on your heart rate during exhalation. When you slow your breathing and extend your exhalation, as you naturally do when walking a labyrinth, you stimulate the vagus nerve and trigger the parasympathetic response.)

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.

(Shortform note: Sternberg focuses on helping patients navigate health care facilities, but research on everyday transit navigation shows how confusing wayfinding creates stress for everyone. The brain processes navigation hierarchically, thinking in terms of “lines” or “routes.” Decision points prompt significantly more brain activity than following a single path. This is why transfer areas in public transit can trigger strong negative emotions—confusion, frustration, and anxiety—which make them more difficult to navigate, whereas design choices that spark positive emotions enhance spatial working memory and help people process navigational cues more efficiently.)

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.

(Shortform note: Walking meetings offer a way to incorporate this principle of Sternberg’s into work life and are especially practical for problem-solving or decision-making conversations that involve small groups of people. Walking increases people’s creativity by over 80% compared to sitting, and outdoor walking in non-straight lines produces the most original ideas. Several powerful healing pathways are at work when you take a walking meeting: The movement activates the vagus nerve, promoting relaxation; outdoor routes often provide nature views and natural light; and walking side-by-side with colleagues breaks down hierarchical barriers and fosters stronger social connections.)

How Expectation, Belief, and Connection Amplify Healing

The fifth and perhaps most powerful pathway involves expectation, belief, and social connection. Sternberg notes 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. Sternberg notes that 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).

How Shared Expectations Amplify Healing

David Robson writes in The Expectation Effect that your brain is constantly making predictions about what will happen next and preparing your body accordingly—which is why a placebo (a treatment with no physiological effect, but which a patient believes has an effect) can trigger the same effects as actual treatments. Research shows that placebos work even when patients know they’re taking placebos: The knowledge that expectations can heal is itself therapeutic. Robson’s research also helps explain why powerful emotions like hope and faith intensify these effects: They create strong predictions that trigger the release of healing neurochemicals like endorphins and oxytocin.

Another reason that expectations are so powerful is that they spread through social networks. Robson notes that specialized brain cells called “mirror neurons” inwardly simulate other people’s actions and emotions. This means you literally “catch” other people’s expectations and beliefs about health, aging, and healing—your susceptibility to social contagion is neurologically built in. This demonstrates why places like Lourdes, where everyone shares positive expectations about healing, can be so powerful: You’re not just bringing your own beliefs, you’re absorbing the hopeful expectations of everyone around you.

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 notes 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.

Social Connection: The Most Powerful Healing Pathway

Sternberg’s call for spaces that support meaningful social practices taps into something fundamental to human psychology. Archaeological evidence shows humans have engaged in social rituals for at least 130,000 years, suggesting this isn’t a cultural quirk but a core human need. Research on ritual psychology reveals that these practices serve three critical functions: They reduce anxiety by providing a sense of control, they help us pursue goals by boosting confidence and focus, and they strengthen social bonds by creating shared emotional experiences. The actions involved in a ritual matter because they create synchrony among participants and focus their shared attention, while the meaning of the ritual matters because it can create hope and reinforce shared values.

When people can’t access their usual social rituals—as during Covid-19 lockdowns—they spontaneously create new ones, like people in cities worldwide going out to their balconies each evening to bang pots and pans together. For hospitalized patients, this means that being unable to participate in social rituals—prayer, family gatherings, or cultural practices—creates a deficit that affects well-being. What Sternberg is advocating for, then, is designing spaces that allow people to maintain these vital connections.