The imposing structures built as asylums in the 19th century not only
housed patients but expressed in brick and stone contemporary ideas of
On August 26, 1993, 135 years of caring for people with mental illness came
to an end as the last 17 patients at Northampton State Hospital in
Massachusetts were helped out the doors to new lives in other settings. At its
peak in the 1960s, Northampton State housed 2,657 patients and employed more
than 500 staff. Once a monument to enlightened care, the asylum complex lay
abandoned for a dozen years, a spooky shell, partially demolished, until
sections were redeveloped as a mixed retail and residential project.
Northampton State's fate mirrors that of the great imposing mental
hospitals that once dominated psychiatric treatment in the United States the
way their buildings dominated local landscapes. Their design—often by
leading architects—embodied their era's best psychiatric thinking.
The 19th-century asylums were that era's answer to the degrading
incarceration by families or local authorities of those incapable of looking
“In 1820, only one state hospital for the mentally ill existed in the
United States,” Gerald Grob, Ph.D., a medical historian at Rutgers
University who studies the history of mental illness in the United States, has
written. “By the Civil War, virtually every state had established one or
more public institutions for that purpose.”
There were earlier American hospitals used for the care of mentally ill
people. One was opened in Philadelphia in 1752 and another in Williamsburg,
Va., in 1773, but these were custodial institutions.
Reformers like Dorothea Dix traveled through Massachusetts and other
states, documenting men and women locked in filthy cages, penned like
livestock in stalls, or shuttered away in almshouses. State legislatures soon
responded. They assumed financial responsibility for mentally ill individuals
and then carried out that obligation using a new approach termed “moral
treatment.” Drawn from earlier British and European models, moral
treatment embraced an enlightened medical model of insanity, supported by a
belief that patients could be treated with some hope of success, like those
with physical disease, rather than merely confined.
Moral treatment also required a change in environment, a removal from
dysfunctional homes and corrupting cities, said Grob, so proponents of the
approach often chose isolated, mid-state locations, like Utica, N.Y., or
Northampton, Mass., or Milledgeville, Ga., although others were in or near
Some patients were long-term residents, but most were admitted, treated,
and released in periods of less than a year. All social classes may have been
represented, according to Grob, but the hospitals met a need for those
patients who were severely ill and had no families or whose families couldn't
“Patients would live a regimented life, eat healthy food, get
exercise, avoid the vice-ridden city, and visit daily with the superintendent
or his wife, the official matron of the institution,” wrote Carla Yanni,
Ph.D., an assistant professor of art history at Rutgers University in the
March 2003 Journal of the Society of Architectural Historians.
Medical treatments were included in this regimen, too. “They typically
gave opiates, warm baths, cold baths, and an arsenal of laxatives.”
As if waiting for a patient who will never reclaim it, a lone chair
faces over the grounds of Buffalo State Hospital.
As if waiting for a patient who will never reclaim it, a lone chair
faces over the grounds of Buffalo State Hospital.
This new therapy could not be provided in old buildings, believed the
psychiatrists of the day, many of whom were founders of what became APA.
Several new asylums were built on linear or hollow-square plans, but the
classic structure was based on the Alabama Insane Hospital, designed by Samuel
Sloan and built in 1852, and codified by Thomas Kirkbride, M.D., in an
influential 1854 book.
The “Kirkbride Model” called for a large building constructed
symmetrically on either side of a central administration building that was
flanked by attached wards set back in steps—“like a row of birds
in flight,” in Yanni's phrase. The division into setback wards allowed
more severely ill patients to be placed by themselves, in the wards farthest
away from the central building. The central building contained offices and
housing for the superintendent and his family and marked the boundary between
men and women patients, who were housed in separate wings.
The shallow V of the Kirkbride model offered several other advantages.
Patient rooms were usually on only one side of the building and so had the
same views, views often enhanced by the work of expert landscape architects.
Both physicians and the architects were intensely concerned about ventilation,
for reasons of comfort and also possibly a carryover from the miasma theory of
disease origin, said Yanni.
“Building patient rooms only on one side was more expensive, but it
was better for surveillance and ventilation,” said Yanni in an
interview. “It meant never having to turn your back on a
By 1890, about 70 Kirkbride-style asylums had been built in the United
Many landscape architects designed asylum grounds as well as great city
parks. For example, Andrew Jackson Downing laid out the National Mall in
Washington, D.C., as well as the grounds of New Jersey State Lunatic Asylum at
Trenton in 1845 and the sprawling North Carolina Hospital for the Insane,
outside Raleigh, which opened in 1856. Frederick Law Olmsted designed New
York's Central Park and the grounds of Buffalo State Hospital. The buildings
of Buffalo State Hospital were designed by famed architect Henry Hobson
Richardson, the first building in what became his signature neo-Romanesque
Ironically, Olmsted also planned the grounds of McLean Hospital, outside
Boston, where he was a patient in his last years.
Olmsted and Downing idealized a life close to the land. “They
believed that human behavior could be explained by environmental factors, that
nature was curative, exercise was therapeutic, and cities were a drain on the
psyche,” said Yanni. “Patients rose early and often spent the
morning outdoors in good weather. After lunch, middle-class patients read and
played games, while working-class patients worked on the farm or in the print
“If the old buildings are today perceived as inhumane, they were
representations of the most advanced thinking in the 19th century when they
were built,” she said. “Doctors believed that rational buildings
would calm the disorderly mind.”
Many institutions often had success with what today would be called
short-term interventions. However, the 19th century also saw a rising tide of
patients suffering from then-incurable psychiatric complications of syphilis
and alcoholism. The need for a high ratio of attendants to patients meant that
asylums became overcrowded institutions, custodial rather than curative.
Empty since 1993, some parts of Northampton State Hospital in
Massachusetts have been demolished while others are now being renovated for
use as housing or retail shops.
From 1890 to 1950, the tide turned. State mental institutions became
surrogate old-age homes, and more than half the admissions were of people over
65, said Grob. “If they could define senility as a psychiatric problem,
the localities could pass the care—and costs—to the
By the mid 20th century, 75 percent of patients were not only old but had
no relatives to care for them. Mental institutions became even more custodial
until radical change arrived in the 1950s and 1960s.
The introduction of psychiatric drugs like chlorpromazine meant that some
mental patients could be treated on an outpatient basis, allowing more of them
to lead lives less constrained by walls and bars.
Psychopharmacology was not the only factor to affect the status of asylums.
The ascendancy of Freudian therapy, the experiences of conscientious objectors
who worked in asylums during World War II, the beginnings of an antipsychiatry
movement, and the promotion of community mental health centers steered the
focus of mental health treatment away from the large mental hospitals after
The main stairwell in the administration building at Harrisburg State
Hospital in Pennsylvania, designed by Addison Hutton under the direction of
hospital director Henry Orth, M.D., replaced an earlier Kirkbride structure
that was deemed outmoded by the late 19th century.
“But perhaps the most important cause was financial,” said
Grob. “The passage of Medicaid and Medicare redefined senility in
psychiatric terms and sent patients to chronic care institutions. This was a
lateral shift from mental hospitals to nursing homes, which were eligible for
Medicaid funds. Other entitlement programs, passed in the 1970s, contributed
even more to the movement out of mental hospitals.”
Psychiatric spaces also changed with the times, said Yanni.
“After World War II, there was a wave of modernist design in
psychiatric architecture. The design of that era favored white walls, linoleum
floors, no applied ornament, and windows that didn't open. People believed
that this clean, hygienic design created a controlled environment.”
Eventually, this antiseptic style was viewed as cold and harsh, she said.
There followed a movement to return to a system of cottages or small
dormitories spread across asylum grounds, which had a prior flowering early in
the 20th century.
In the 21st century, design of mental hospitals reflects newer concerns,
like privacy. The new 192-bed building at the private Sheppard Pratt Health
System in Towson, Md., serves as an example. It replaces the original 1891
structure designed by Calvert Vaux, who worked with Olmsted at Buffalo State.
The building has two sets of corridors, one permitting limited access for
visitors and another to allow patients and staff to circulate out of sight of
outsiders. Consulting rooms are located near the entry to units for greater
privacy. Nurses' stations are not at the end of the wards but in the center,
with short corridors radiating outward for better visibility. Units are built
on the same plan but vary, depending on patient needs. The adolescent wards
have bench beds, and showers in the bathrooms are on 90-second timers so young
patients don't stop up drains and walk away. In the adolescent
neuropsychiatric unit, the nurses' station also has glass panels to protect
the desk from unruly patients. Extra sets of doors permit lengthening or
shortening the corridors connected to the main building as the patient census
While 19th-century buildings have gone out of use, said Yanni, few have
“Places like Northampton are physically difficult to tear
down,” she said. “They are enormous. Some are half a mile long.
They are usually made of stone, and all the walls are load bearing, down to
10x14-foot patient rooms. Many were fitted with asbestos-coated pipes in the
1950s, and the abandoned ones are full of rabid cats. So the state-owned ones
just sit there.”
The fates of others vary. The older, west campus of St. Elizabeths in
Washington, D.C., is boarded up while crews work to stabilize the 56 buildings
on the site. State government offices are slowly taking over Harrisburg State
Hospital in Pennsylvania as patients move out to community settings. The farm
formerly attached to Buffalo State Hospital is now occupied by Buffalo State
College. Parts of Richardson's buildings, now on the National Register of
Historic Places, are occupied by the Buffalo Psychiatric Center, and talks are
under way to use other areas for a school. The former hospital in Traverse
City, Mich., has been developed into a mix of retail and residential
Old asylums seem to fascinate some. The ghost of Northampton echoed to a
special sound installation prepared by German-American artist Anna Schuleit in
November 2000, which otherwise lies idle while the state decides what to do
with the property.
All told, more than 250 asylums were constructed in the United States in
the 19th century, an enormous commitment of public will and funding, said
Yanni. Yet the field they were erected to serve has progressed through so many
stages—of which only the latest is deinstitutionalization—that now
they are viewed as relics. Whatever their present state, asylum buildings
represent a physical memorial to the patients and those who cared for them for
almost 200 years.
If “architecture manifests scientific knowledge,” as Yanni
observed, then the crenellated palaces and castles of 19th century insane
asylums certainly expressed in brick and stone their vision of psychiatry.
“They remain as witnesses to the history of medicine and testaments
to a once-common faith in environmental determinism,” said Yanni.
A wicker coffin rests at St. Lawrence Psychiatric Center in Ogdensburg,
N.Y., on the Canadian border.