How the Medicalization of Architecture is Making Us Worse Off
In 1929, Swiss-French architect Le Corbusier declared that homes should be “machines for living”. His vision of spotless white walls and open spaces was shaped not just by style, but by the fight against disease. Nearly a century later, we’re still living in houses that function more like a clinic or sanatorium: sealed, sanitized, and obsessively controlled. The modernist home is a paradox, it promises health and cleanliness but isolates us from the very ecosystems that keep us alive. Bacteria, fungi, and microbes - long feared and excluded - are now understood as vital to our health. So why does design still reject them?
The Sanatorium
Modern architecture as we know it was shaped in the early 20th century, a time driven by industrial efficiency, rapid technological advancement, but also by a profound anxiety about an illness that was tormenting Europe: tuberculosis.
Tuberculosis is a fundamentally urban disease, thriving in the damp, crowded conditions of industrial cities. Being a respiratory disease, it spread quickly through poorly ventilated housing. Architects were quick to proclaim themselves doctors, turning their work into a medical regime. Le Corbusier was among the most zealous of these self-proclaimed architectural doctors. In Towards a New Architecture (1932), he manifests, “the machine we live in is an old coach full of tuberculosis” framing the home as a pathological site in need of radical intervention. In Urbanisme (1925) he describes the city as diseased, calling for a "cure," concluding that "surgery" is required to remove the "cancer" of degenerate street layouts and "rotten old houses full of tuberculosis." His proposals were clear: antiseptic white walls, the removal of ornament as it might breed bacteria, sinks at the entrance of each home to avoid contamination from the outside, and many more.
If you’ve ever opened an architectural history book, you might have noticed quite a few hospitals belonging to the Modern period. The first building in Switzerland to be ever built out of concrete and steel was the Schatzalp sanatorium, one of just 26 sanatoriums in the city of Davos. It had steam floor heating and a flat roof with internal drainage - the most innovative technologies in architecture coincided with the most advanced medical treatments. With all these developments, social roles were reversed; whilst before hospitals were for the poor and the rich were treated at home, now the newest sanatoriums became exclusive retreats for the elite. These modern spaces were linked to luxury, privacy and isolation from the “real” world, an escape oddly parallel to today’s infamous celebrity rehab centres, in the comfort of a controlled regime and removal from public life.
The sanatorium even became the setting for Thomas Mann’s novel The Magic Mountain, in which when a patient is asked what cure they are taking, he replies “Cure? Oh, I’m having myself electrified a bit. [...] I will tell you the real reason I am here, Madame. It is a feeling for style… This brightness and hardness, this cold, austere simplicity and reserved strength - it has upon me the ultimate effect of an inward purification and rebirth.” The sterility of the sanatorium became aspirational, a symbol of moral and physical purification, reinforcing the idea that cleanliness is not just about hygiene but about an entire way of life. In this pursuit of purity, the human ceases to be an ecological being and becomes an architectural one, living its days in symbiosis with concrete and steel.
Expansion into Home Design
This style quickly started dissipating outside of sanatoriums and into people’s homes. In the words of Otto Wagner, “Modern man is born in hospital and dies in hospital: consequently he should also live as if in a hospital!”. Many iconic modern architecture elements derive from medical purposes. Le Corbusier’s famous pilotis were not developed so much for aesthetics, but rather to detach the house from the “wet, humid ground, where disease breeds”. Alvar Aalto’s Paimio chair, which currently inhabits many people’s living rooms, was originally designed to open up the chests of patients with tuberculosis. The sick person was the ideal client of modern architecture.
Today, we still see many of these sanatorium design principles being still applied in our homes. By understanding where this kind of design comes from, we are able to evaluate whether it is still relevant or not. And unfortunately, while germ theory was fundamental at the time to begin understanding diseases and how to cure them, we now understand that our interactions with microorganisms, and nature overall, are much more important for our health than we originally believed.
Dangerous Asepticism
We like to think of ourselves as individuals – contained, autonomous, clean – neatly defined by the boundaries of our own skin, and our architectures, but beneath this illusion of separation our bodies are populated by 38 trillion bacteria, even outnumbering our human cells, which make up a mere 30 trillion. Each human is an ecosystem in itself, porous, interconnected, and utterly dependent on microbial life. Although some of them are in fact dangerous and harmful, the cultural scar they left and its consequent demonisation is unfair to the majority of these living organisms. Many of them help regulate the entire planet's biochemical cycles, from the air we breathe to the fertility of our soil. They sustain biodiversity across all scales; to be alive is to be in constant collaboration with microbes, whether we acknowledge it or not.
Emerging research reveals that insufficient interaction with microorganisms can contribute to mental health issues, autoimmune disorders, and gastrointestinal syndromes. The gut microbiota, comprising trillions of microorganisms residing in the gastrointestinal tract, is pivotal in regulating immune homeostasis, with imbalances potentially leading to allergies and autoimmune disorders, as well as inflammatory diseases. Studies have demonstrated that changes in the gut microbiome may contribute to conditions such as anxiety and depression. Excessive cleanliness and reduced exposure to natural environments can limit necessary microbial interactions, potentially weakening immune responses and increasing susceptibility to allergies and autoimmune conditions. While hygiene is important, over-sanitization deprives the human system of essential stimuli required for its proper development and function.
The 21st century is witnessing an unprecedented loss of microbial diversity, both in human bodies and in the environment. Reclaiming microbial life is not about abandoning modern architectural hygiene but about questioning and redefining it. True cleanliness is not in sterility, it is in balance, an ecosystem in harmony rather than an empty void. Our built environments, designed as fortresses against the dangers of nature, have instead become grounds for chronic illness, immune dysfunction, and mental distress, what many call “sick building syndrome”. As our understanding of microbiomes deepens, the cracks in this ideology are beginning to show. Architecture must move beyond its clinical legacy and into a new paradigm, one that rewilds our built environment and acknowledges that buildings are not isolated capsules, but living homes.
In our quest to make homes cleaner, we’ve made the environment sterile, not just for bacteria, but for us. Without microbes, the ecosystems inside our walls and within our bodies are falling apart, modern architecture has inadvertently designed sickness into its very foundations; this stylistic choice is suicidal. Architecture must move beyond its clinical legacy and into a new paradigm, one that rewilds our built environment and acknowledges that buildings are not isolated capsules, but living homes.
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