– Excerpted from “Phantoms of the Kirkbride Hospitals,” Robert Kirkbride, Places Journal, 12.2024
During the second half of the nineteenth century, approximately seventy-eight “Kirkbride Plan” psychiatric hospitals were constructed to treat the mentally ill across the United States, Canada and Australia according to the formal arrangements proposed by Dr. Thomas Story Kirkbride (1809-83) and the patient-centered principles of the Moral Treatment that he and social reformer Dorothea Dix (1802-87) tirelessly advocated. While they were certainly not alone in their efforts to elicit greater respect for the mentally ill and to alleviate their suffering and stigmatizing isolation, Kirkbride and Dix were complementary forces who envisioned a better future for the mentally ill, and for a brief window of time, they willed that humane vision into being.
Embodying Enlightenment Quaker beliefs in the therapeutic powers of architecture, beauty, and respectful care, the Kirkbride Plan generated elegant and massive echelon-wing structures that embraced local climate and site conditions to provide patients with prevailing breezes, plentiful sunlight, and expansive vistas of bucolic, landscaped grounds that often included a self-sustaining farm for food and occupational therapy. Supplied with greenhouses, workshops, magic lantern theaters and other innovative amenities, “Kirkbrides” provided a self-sufficient retreat from the outside world and a dignified place for the placeless.
In October 1844, Dr. Thomas Story Kirkbride and twelve of his peers founded the Association of Medical Superintendents of American Institutions for the Insane (a precursor to the American Psychiatric Association) and elected Kirkbride as Secretary. In articles published in AMSAII’s The American Journal of Insanity in 1847 and 1849, and in an early hospital built to his guidelines at Trenton, New Jersey, Kirkbride developed an idealized model of a residential facility to treat mental illness, generating a set of propositions that were adopted by AMSAII in 1851 and formed the basis for his 1854 treatise, On the Construction, Organization, and General Arrangements of Hospitals for the Insane with Some Remarks on Insanity and Its Treatment. In its 80 pages, Kirkbride offered a blueprint that influenced the rapid construction of dozens of facilities.
The Linear Plan, as Kirkbride called his signature configuration, featured a central administration building flanked symmetrically by wings (one for women, the other for men), with shallow setbacks, in echelon, as seen in Sloan’s 1854 drawings for a state hospital at Tuscaloosa, Alabama. This v-shaped “batwing” arrangement provided light and air to disperse the miasma of foul odors, believed to be a primary source of illness. The wings also structured daily life at the institution. Patients were strategically distributed according to the nature and degree of their illnesses, with the most “excitable” cases placed in the outer wings. Patients closer to the Central Main building, where the superintendents often resided with their families, were closer to returning to the world.
The plan was continually modified to improve performance. At St. Elizabeths, in Washington, D.C. (1852) — the only federal facility built on the Linear Plan — the wing setbacks were deepened to allow for fireproof stairways and enhanced ventilation, natural lighting, and exterior views. With each hospital built over the following decades, the formal arrangements were adapted to meet site conditions and financial capacity, as well as advances in construction and technology. In 1880, Kirkbride published a second edition of his treatise, expanded to 341 pages and featuring the “Improved Linear Plan,” with bay-windowed communal spaces at the middle and outer end of each wing, and centralized rear support buildings.
Yet, despite the noble intent of their builders and the generosity of their designs, Kirkbride Plan hospitals now haunt the popular imagination due to an abysmal cocktail of overcrowding, institutional neglect, and questionable medical procedures. During the first half of the twentieth century the majority of American psychiatric hospitals, including Kirkbrides, devolved into frightening dystopias, offering cautionary reminders of the frailties of human infrastructures, and the perils of bureaucratization and an overly generous confidence in architectural determinism.
The Kirkbride Plan hospitals offer three dimensional documents of the historical challenges encountered in providing physical and social infrastructures for mental healthcare, and their erasure is tantamount to the repression of a very real, very difficult cultural past that continues to haunt our present and, foreseeably, our future. Close readings of the buildings, their grounds and the traces of their occupation – including patients’ possessions, ephemera and burial markers – render legible not only the vestiges of actual pasts, they also lend voice to what might have been, or might yet be.
The remaining Kirkbride Plan hospitals offer remarkable opportunities, educationally and financially, and their revitalization is both commonsense and achievable. To preserve buildings with complex histories, though, many voices need a seat at the table, with a shared understanding that there isn’t one single, omniscient history, but many histories experienced from many different views. Such views include an emerging generation of Kirkbride (and asylum) enthusiasts who do not share the stigmas about mental illness that were held by previous generations. At PreservationWorks, we don’t seek to erase or bury the past but to engage with it, to learn from it, to challenge and transform it.
Join us in the effort!
Dr. Robert Kirkbride
PreservationWorks Spokesperson