The Dark Past of Mental Health Care
In the 18th and 19th centuries, those suffering from mental illness were often locked in basements or prisons, subjected to inhumane conditions. The prevailing belief was that patients were responsible for their own affliction—abandoned by God, possessed by demons, or guilty of some terrible deed.
A Ray of Light: Dorothea Dix
Dorothea Dix exposed these abuses, describing patients naked, chained, caged, beaten, and whipped. Her advocacy led to the creation of the first asylums, and behind them stood a visionary: Dr. Thomas Story Kirkbride.
Dr. Kirkbride and the Plan
Dr. Kirkbride believed in the concept of "Moral Treatment"—that permanent confinement was not the solution. He argued that patients' surroundings, exposure to sunlight, and fresh air were crucial for proper treatment, and he applied architecture as a therapeutic resource.
The Kirkbride Plan envisioned asylums arranged in a bat-like pattern, with six to eight pavilions. Each ward, room, and hall received equal amounts of air and sunlight. Patients were separated by gender and condition, with the most severe cases at the outer ends and improving patients moved closer to the exit.
Palaces of Healing
The resulting buildings were nothing short of palaces, with expansive green spaces, farms, and greenhouses. Kirkbride left no detail to chance, documenting his process in his work "On the Construction, Organization, and General Arrangements of Hospitals for the Insane With Some Remarks on Insanity and Its Treatment." He specified construction materials, paints and colors, techniques for eliminating foul odors, and even the profile and salaries of staff. The asylum operated like a Victorian family, with shared meals and the doctor at one end of the table and the head nurse at the other.
Rise and Fall
In 1840, there were only 18 asylums in the United States; by 1880, there were 139. The Kirkbride Plan had become a success, with these asylums becoming symbols of progress, even appearing on stamps and postcards. But problems emerged. Kirkbride insisted on a maximum of 250 patients, but new regulations allowed up to 600, clearly for financial reasons. The Buffalo Hospital in New York took twenty years to build and constantly lacked staff. Moreover, patients did not leave. The idea was that they would stay no more than a year, and Kirkbride claimed an 80% cure rate, but these claims were unsupported. In reality, if a Kirkbride filled up, it stayed filled.
Decline and Abandonment
Patients who could afford better care were sent to private hospitals, while the Kirkbrides became refuges for the poor and indigent. By the mid-20th century, they collapsed. The new buildings were virtual prisons—exactly what Kirkbride had sought to avoid. In the 1960s, psychiatric patients were prohibited from working, and deinstitutionalization in the 1970s delivered the final blow. Today, many Kirkbrides stand abandoned, yet they retain a glimpse of the doctor's vision, and some have been partially repurposed.
(From our archives, originally published in December 2019, with some edits, and a photograph of Dorothea Dix)
Source:99% Invisible
