On the Construction, Organization and General Arrangements of Hospitals for the Insane (1854)

Dr. Thomas Kirkbride was born in 1809 in Pennsylvania. He went to the University of Pennsylvania Medical School originally intending to become a surgeon. However, in 1840 after his training and internship at Friends‘ Asylum, he was offered to become the superintendent of the newly established Pennsylvania Hospital of the Insane. “His ambition, intellect, and strong sense of purpose enabled him to use that position to become one of the most prominent authorities on mental health care in the latter half of the nineteenth century.” He soon became the founding member of the Association of Medical Superintendents of American Institutions for the Insane, and later was elected the president of the American Psychiatric Association. From his involvement in these organizations and from his writings, he promoted a standardized method of hospital construction and mental health treatment for the insane which is commonly known as “The Kirkbride Plan.” He wrote many articles and reviews for medical journals and also published three books. His third book, On the Construction, Organization, and General Arrangements of Hospitals for the Insane (1854), was a very technical and thorough collection of his theories on the topic. Dr. Thomas Kirkbride’s theories on the architecture, activities, and medical treatment for the mentally ill were the precedents that formed how the mentally ill were treated in the United States society.

Before Kirkbride’s standardized methods for mental hospitals, those with mental illness suffered crude and inhuman treatment. Beginning in Colonial America society, people suffering from mental illness were referred to as lunatics. Colonists viewed lunatics as being possessed by the devil, and usually were removed from society and locked away. The only medical treatment for mental illness considered at the time was to expel crisis from the individual. “Such medical procedures involved submerging patients in ice baths until they lost consciousness, executing a massive shock to the brain, inducing vomiting and draining large amounts of “evil” blood.” Around 1800, the Europeans fortunately introduced a new approach that replaced the shackles and cement jail cells with a more domestic feel. These facilities that the Europeans introduced were called asylums or country houses. The Europeans discovered that recovery was much more likely if their environment simulated a home. However, the lack of restraints resulted in problems in situations where the patients became unruly. Steady yet slow progress of mental health treatment continued throughout the early 1800s.

The mid 1800s is when the small privately owned asylums transformed into government controlled mental hospitals. Dr. Thomas Kirkbride was the one that lead this transformation in the United States. In 1954, after 14 years of serving as the superintendent of Pennsylvania Hospital for the Insane, he published On the Construction, Organization and General Arrangements of Hospitals for the Insane. This book extensively explained his theories for treatment of the mentally ill. The first several chapters Kirkbride explains what insanity is medically understood to be and also frequency and curability of insanity. The next portion of the book explains what the current state laws regarding hospitals for the insane were. Throughout the rest of the book he gets into the specifics which range from the heights of the beds, to the distribution of food, to the materials of walls. There are many crucial elements to point out. The most important detail is the overall architectural layout of mental hospitals that Kirkbride proposed. It consisted of a central administration building flanked by two narrow wings. This gave it a very hierarchical design. One wing was for male patients and the other for female. Each wing was sub-divided by ward. “The more “excited” patients were placed on the lower floors, farthest from the central administrative office. The better behaved and more rational patients were housed in the upper floors and closer to the central administrative structure.” The reason for the wings to be narrow is so that every room had a window with a view. This arrangement would make patients more comfortable by isolating them from patients with illnesses antagonistic to their own. The emphasis on keeping the wings narrow was for allowing fresh air, natural light, and a view of the hospital’s surroundings from all sides of each ward. It only seemed necessary for this hospitals to be built in small rural towns away from the from urban areas. Landscaped parks were commonly included in designing the mental hospitals, this served to both stimulate and calm patients. Many of the patients took part in gardening to make the hospital more self-sufficient and also giving the patients a sense of purpose and responsibility as well as improve physical