Architecture: The Kirkbride Plan

Kate and I would agree that Kirkbride asylums are easily one of our favorite things to talk about; their architecture is arguably the most impressive we’ve ever seen.  In fact, this is one of the things that instantly made us friends!  “You love Kirkbrides? Me too!”  Almost every state in America had at least one of these institutions; and many states had more than one.  In our prior post, I mentioned that I grew up near the Trans-Allegheny Lunatic Asylum in West Virginia and Kate lived near Northampton State Hospital in Massachusetts (both Kirkbrides).

In this post, we want to give you the history of Kirkbride asylums, the man behind the architectural plan, and hopefully a good reason why you should love these buildings, too.
Fair warning: if we went into all the specific details, this post would be hundreds of pages long…and we don’t want you to fall asleep. In future posts, we will highlight individual hospitals to cover their history specifically.

Prior to the turn of the 19^th century, those suffering from mental illness were often locked up in basements, attics, poorhouses, and prisons.
It was much easier to shackle a schizophrenic to a wall than to provide the help they needed.
Often times, these individuals were left without the basic needs of food, water, and clothing; their living conditions were beyond inhumane.  Society’s thinking at this time was “out of sight, out of mind”.  Mental illness was viewed as an embarrassment and some even thought it was a sign of demonic possession.  These were society’s unwanted and forgotten.

The Man with The Plan

In 1840, a physician by the name of Dr. Thomas Story Kirkbride (pictured right) became the superintendent of the Pennsylvania Hospital for the Insane in Philadelphia. 

In 1844, he took part in meeting with other hospital superintendents to form the country’s first national medical society:  the Association of Medical Superintendents of American Institutions for the Insane.  Today, this organization is known as the American Psychiatric Association.

Dr. Kirkbride was arguably one of the most influential pioneers in mental health history and was an advocate for “moral treatment” of the insane (our hero).  Moral treatment meant that patients would be treated with respect and dignity, no matter who they were.  Kirkbride said  “…for I know of no reason why an individual who has the misfortune to become insane, should, on that account, be deprived of any comfort or even luxury..."  For the first time, the insane were being seen as people and not just their illness.  He had a vision that state hospitals for the insane could be built  to a certain architectural plan that would be appealing to both patients and the public alike.  In his book, On the Construction, Organization and General Arrangements of Hospitals for the Insane, Kirkbride outlines a detailed plan of asylum construction and operations.  This book was first written in 1854 and then revised in 1880.  These institutions would be a sanctuary for patients and the buildings themselves would be part of their therapy.  As a psychology major, it’s disappointing to me that we never learned more about Dr. Kirkbride in college.

Perhaps Dr. Kirkbride’s biggest advocate was author, teacher, and reformer, Dorothea Dix (pictured left).  In 1841, Dix went to teach Sunday school at the East Cambridge Women’s Prison in Massachusetts.  She was so appalled by the inhumane living conditions, it sparked her crusade to travel around the state to document the conditions of the mentally ill.  Dix’s grandmother was a wealthy woman and knew powerful people...  Dorothea used this to her advantage to convince the state of Massachusetts to expand the state hospital in Worcester. 

Traveling over 30,000 miles in 3 years, Dorothea met with many state legislatures to persuade them to provide better living conditions for the mentally ill.

In 1848, Trenton State Hospital in Trenton, New Jersey was the first asylum to be built based on the Kirkbride Plan.  Ironically, Dorothea would fall ill later in life and live at the hospital in Trenton, where she died in 1887.

The Kirkbride Plan

The most distinctive feature of the Kirkbride Plan is that the building itself would resemble a shallow “V”. There’s one core Administration section and the patient wards stagger off each other spreading outward.  It was incredibly important to Dr. Kirkbride that each ward wing sprawl from the next en echelon so there was plenty of fresh air and sunlight, plus unobstructed views for the patients.  The more well-behaved patients with less severe illnesses were housed on the higher  floors, closer to the Administration section, while the more violent and severe patients were housed on lower floors in the outer wards.  This was because when visitors came to the asylum, the staff did not want their most dangerous patients to be seen or heard.  In the earlier years, the upper floors of the center Administration section would house the hospital superintendent and their families.

(Photo Credit: Fergus Falls Journal)

(Photo Credit: traversecitymi.gov)

The wards were also segregated by sex; males in one wing, females in another.  Since males and females were housed on opposite sides of the building, outer buildings such as the chapel, kitchen, library, and auditorium were built directly behind the center Administration area for easy access.
(Top photo below: Ward C, Violent Female Ward, Trans-Allegheny Lunatic Asylum;
Bottom photo below: Ward F, Violent Male Ward, Trans- Allegheny Lunatic Asylum)




The Kirkbride Plan proposed these asylums be between 3-5 stories tall and house 250 patients, although the more modern plan could hold up to 600 patients… about 15 patients in each ward depending on the severity of their conditions.   These wards were to have a parlor, a dining room with a dumbwaiter (this made providing food for the 250 patients much easier), single lodging rooms, dorms with multiple beds, and bathrooms.

The staircases were large and winding, referred to as “coffin-style”. Depending on the geography of the land on which they were built, sometimes the building structures would be modified.

Each Kirkbride had a different architect, so while the architecture plan remained the same, they all had their own unique characteristics. 

The buildings were elegantly decorated with Victorian-era furniture and rugs.
Dr. Kirkbride insisted these institutions have a “cheerful and comfortable appearance, everything repulsive and prison-like should be carefully avoided”.
The ceilings were supposed to be at least 12 feet high and hallways at least 12 feet wide.  The photos above and below are my photos from the Trans-Allegheny Lunatic Asylum.  (It really showcases the amazing preservation they’re doing). 

 

At least 100 acres of land were to be set aside for the asylum grounds… this was to give plenty of room for the gardens, farms, and exercise areas.  The hospital grounds were to be well maintained and aesthetically pleasing.  Most asylums had their own working farms, tended to by patients as a form of exercise and therapy.  If they had a productive outlet, it was thought to help cure their illness.  The locations for these asylums were in a more rural environment, away from the chaos of a big city.  However, they were to be close enough to a sizeable community or near a railroad for convenience of supplies and hiring outside work.

Towards the end of the 19^th century, there was little to no evidence that the buildings themselves provided a cure for mental illness.  In the 20^th century, the overcrowding of patients made the staff to patient ratio impossible for every patient to receive adequate care. 

(Photo credit: https://www.facebook.com/MJLondonphotography)

In fact, some patients were mistreated, abused, and forgotten.  In 1955, the number of  people living in public psychiatric hospitals peaked at 560,000.  Many lawsuits were brought against these institutions for the living conditions and treatment of patients… literally, patients would be tied to beds covered in their own feces and may not have eaten for days.  Funding from the government was often cut short due to bad economic times and war.

Deinstitutionalization began in the 1950s and 1960s with the introduction of Chlorpromazine, better known as Thorazine and other anti-psychotic drugs.  There was no longer a need for long-term psychiatric stays; patients could now function in society with community mental health resources.  However, patients with chronic or severe illness could not function in society and ended up homeless.  In 1963, President John F. Kennedy signed the Community Mental Health Act to provide federal funding for  more community-based facilities.  This program was never fully funded due to the Vietnam War.  In 1980, President Jimmy Carter signed the Mental Health Systems Act, which was to improve community mental health programs and provide more services for those with long-term illness.  In 1981, President Ronald Reagan signed the Omnibus Budget Reconciliation Act that repealed Carter's legislation, giving block grants for the states; federal mental-health spending decreased by 30 percent.

In addition to budget cuts, the Kirkbride asylums were too large, not up to code, and too expensive to keep up and running.  New hospitals for the insane shifted towards multiple smaller buildings often connected by underground tunnels, called “The Cottage Plan” (which we’ll cover in a future post).


(Photo credit: https://www.facebook.com/MJLondonphotography)

If you’re interested in more specifics about the Kirkbride Plan, pick up Dr. Kirkbride’s book mentioned earlier: On the Construction, Organization and General Arrangements of Hospitals for the Insane.  The amount of detail that Kirkbride outlines is truly amazing… everything from the size of doors and windows, heating and ventilation systems, lighting, height and size of rooms, staff on hand, and more. 

Throughout the years, many Kirkbride asylums have been lost to due fires, vandalism, neglect, and demolition… 


(Photo credit: nj.com)

A few that are still standing have been renovated to apartments, hotels, and offices, and some are still in use as hospitals.  Thankfully, a handful of these institutions have opened museums dedicated to the hospital’s history, such as Patton State Hospital in San Bernadino, CA; Oregon State Hospital in Salem, OR; St. Joseph State Hospital in St. Joseph, MO; Trans-Allegheny Lunatic Asylum in Weston, WV; and more. 

(Photo cred: https://www.facebook.com/MJLondonphotography)

-J