The Architecture of Madness: Insane Asylums in the United States

by Carla Yanni
University of Minnesota Press, Minneapolis, 2007
256 pp., illus, 120 b/w. Trade, $82.50; paper, $27.50
ISBN: 0-8166-4939-1; ISBN: 0-8166-4940-5.

Reviewed by John F. Barber
Digital Technology and Culture, Washington State University Vancouver

jfbarber@eaze.net

Nineteenth-century doctors did not agree on the nature or causes of insanity. They did, however, agree that much of the insanity exhibited by Americans of that time was curable with the help of specially designed buildings. The Architecture of Madness is, at its heart, an exploration of the architecture for the care and treatment of insane persons during the nineteenth century.

More than simply a history of buildings, however, this new book by Carla Yanni, associate professor of art history at Rutgers University, demonstrates how ideas regarding the therapeutic values of architecture were closely connected to changing social and medical paradigms.

Socially, the number of insane asylums increased in the nineteenth century. Scholars of the history of psychiatry point to several reasons. First, the geographical separation between the workplace and home created splintered, smaller, specialized families that undermined the ability to care for needy members. Healthy individuals, who needed to work for a living, increasingly sought help from paid care-givers or the state for family members stricken with insanity, thus creating a new market economy. More fundamentally, the presence of an insane relative threatened the nuclear family and the sanctity of the home, both central components of the Victorian era mindset.

Both families and doctors faced a paradox when it came to committing relatives, however. Insane asylums were not seen as the sort of place to send a family member, especially with the general conception of insane asylums as large, unwelcoming, cold and dark, their residents sitting unclothed, shivering on dirty floors, shackled to the walls.

Dr. Thomas S. Kirkbride, a Philadelphia Quaker, believed good architecture was essential for the treatment and recovery of lunatics, and it was his "linear plan," short but connected pavilions arrayed in a shallow V, that dominated the architecture and building of insane asylums from 1840 to about 1880. These buildings, built in styles to mimic Greek temples, classical cathedrals, and Arts and Crafts cottages, attempted to communicate a message of generosity, civic munificence, and kindness to those less fortunate.

Coupled with ideas regarding the importance of proper ventilation, the benefits of outdoor activities, and restful landscaping, these insane asylums, most often located on the outskirts of cities, attempted to provide a refuge from the stress and turmoil of urbanization.

The Architecture of Madness tracks these parallel histories through a series of tightly conceived chapters. The first chapter introduces the Victorian understanding of moral management as a treatment for the insane by which diverting activities such as walking, boat trips, acting in skits, and sleigh rides were meant to inculcate patients with self control and positive thoughts, all part of the cure for insanity, and all part of the internal culture of an asylum.

Chapter 2 focuses on Kirkbride's "linear plan" and its development in several asylums throughout the United States to about 1880. In addition to the architectural design, described above, Kirkbride advocated segregating patients by severity of illness, ease of treatment and surveillance, and ventilation. These factors were purpose built into many of the structures following his lead.

Chapter 3 presents alternatives to the linear plan. Interestingly enough, however, these alternatives were not so much focused on buildings, either large or small, but rather on medical treatments and moral management, which, although different, still claimed the same beneficial results.

In the second half of the Nineteenth Century, following the American Civil War, insane asylums exploded in numbers and in size. The average number of inhabitants increased from 250 to 600. Larger asylums were built to accommodate them. Chapter 4 deals with these grand institutions.

Additionally, asylums established on principles of architectural environment fell into disfavor in the 1890s when neurologists mocked asylum doctors for their lack of scientific research. By century's end many asylums had become human warehouses, exactly an outcome Kirkbride had argued against earlier.

In the end, Yanni's point is well made: Nineteenth Century doctors believed architecture was part of the cure for insane persons thought likely to improve, and part of the treatment for those chronically ill. In either case, treatment of the insane was conducted not only in, but by, the asylum.

By 1900, the focus on the therapeutic value of architecture and environment was no longer a key goal of asylum managers. Their buildings were crowded with those still unwell, despite 60 years of treatment. The psychiatric profession needed to disassociate itself from the claims of environmental determinism since, obviously, the environment (including the architecture of the asylums themselves) had not determined many cures for insanity.

More and more frequently through the Twentieth Century patients suffering from insanity were proscribed outpatient care. Today, the severely mentally ill are all but invisible, sequestered in state hospitals. And, as treatment emphasis has shifted to milder, non-institutionalized cases of mental illness, architecture has declined in importance to the field of psychiatry.

While it was at the forefront of treatment for mental illness, architecture was, as Yanni explains, deeply intertwined with then prevalent social, intellectual, and medical currents.

The Architecture of Madness tells the story of this intertwining in a fresh and original way.