New York was not alone in providing care for the mentally ill. From the mid-nineteenth to the early twentieth century, close to 300 institutions for the insane were built throughout the United States. In 1840, there were only eighteen asylums, but by 1880 that number had jumped to 139. Even in the midst of the Great Depression and World War II, when shortages of resources, funding, and qualified staff burdened the system, the hospitals survived and continued to be filled beyond capacity. A nationwide survey published in Illinois, in 1948, counted 339,000 patients ill 261 state mental hospitals and residential schools for “mental defectives,” sufferers of epilepsy, and other neurologically handicapped persons. And so it was that one of every 263 Americans lived in such institutions – a statistic that did not include patients in private hospitals. The cost to the State of New York which alone cared for 95,000 people in 27 institutions, and employed more than 24,000 persons to do so, accounted for over a quarter of the state’s annual budget.
For more than half the nation’s history, vast mental hospitals were prominent architectural features on the American landscape. Practically every state could claim to have at least one. The catalyst for their creation was the schoolteacher-turned-reformer Dorothea Dix, who, beginning in the early 1840s, traveled the country lobbying states to build hospitals for the proper care of the “indigent insane.” Dix’s humanitarian appeals were persuasive, and they were well timed: expansionist America was eager to erect large civic institutions that would serve as models of an enlightened society. Public schools, universities, prisons, and insane asylums were all part of this agenda, though high-minded rhetoric was not always matched by the less-than-altruistic motives of politicians. As David J. Rothman asserts in The Discovery of the Asylum, political leaders intended to “buttress the social order” and to counter the perceived ills of increased urbanization, immigration, and population growth. This was often achieved by moving problem populations out of view.
Dix was the catalyst for the first wave of asylum building, but it was Thomas Story Kirkbride who provided the blueprint for their expansion. As superintendent of the Pennsylvania Hospital for the Insane in Philadelphia, Kirkbride drew on his own experience and travels abroad to European counterparts to devise a model asylum. His work culminated in the treatise, On the Construction, Organization, and General Arrangements of Hospitals for the Insane, which was endorsed by the Association of Medical Superintendents of American Institutions for the Insane and adopted as its guidebook for the construction of mental hospitals in the United States.
A skilled administrator, Kirkbride was obsessed with asylum design and management. He believed that a well-designed and beautifully landscaped hospital could heal mental illness, and that by removing the afflicted from society and placing them in a peaceful environment filled with a regimen of structured activity performed under the paternal supervision of a strong superintendent, many would regain their senses and be able to reenter the outside world as improved individuals. This concept of therapy was known as “moral treatment.” As the program spread throughout the country and giant investments were made in the construction of the hospitals, so, too, grew the profession of psychiatry. The historian Carla Yanni, in her definitive study, The Architecture of Madness, observed that “the professionalization of psychiatry as a specialty took place in asylums,” as it became publicly accepted that lunacy could only be cured in a hospital, not at home.
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