Carla Yanni
THE ARCHITECTURE OF MADNESS
Insane asylums in the United States
256pp. Minneapolis: University of Minnesota Press. $82.50.
978 0 8166 4939 6
Readers of a certain age will doubtless recall the Victorian museums of
madness that once haunted the countryside on both sides of the Atlantic,
vast, straggling buildings that provided mute testimony to an earlier
generation’s enthusiasm for segregative responses to mental illness. The
peculiar moral architecture that our ancestors constructed to contain the
dissolute, the degenerate, and the deranged was unmistakable once seen, and
even now some remarkable examples survive. Travelling on America’s East
Coast, for example, the highway affords views of the distinctive outline of
the State Hospital at Augusta, Maine, and the still larger and more striking
buildings that made up Danvers State Hospital in Massachusetts, on the
northern fringe of the Boston suburbs.
Some older folk out there may involuntarily have had an even more intimate
acquaintance with establishments of this sort, once to be found all across
Europe and North America. Perhaps they have visited a close relative locked
up in one, or they may even have had personal experience of life on a mental
hospital ward. For them, the striking and sinister images that impress
themselves on casual passers-by will have a deeper resonance, the visual
reminders augmented by memories of more intimate contact with the realities
of confinement in a barracks-asylum, not least the peculiar and
unforgettable smells that distinguished these places and clung to the
physical fabric like a foul miasma: of wards impregnated with decades of
stale urine and faecal matter, of the slop served up as food.
Small wonder that, as Carla Yanni confesses at the outset of her book, she
once shied away from the asylum’s architectural history, “overwhelmed by its
grimness”; or that her parents were doubtful about her obsession with this
unglamorous and depressing subject matter. Fortunately, though, Yanni
overcame her initial disposition to leave these buildings to moulder in
peace. She focuses, as her title indicates, on the United States, and
devotes most of her attention to the nineteenth and early twentieth
centuries, the period that marked the real Great Confinement of the insane.
Drawing on her background as an art historian, she has produced a
fascinating and visually rich survey of this strange territory. She has read
widely and wisely in the history of psychiatry, and, though she makes a
factual error here and there, for the most part she is very successful at
linking together architecture and mental medicine.
Knowledge of both worlds is vital, because the births of the asylum and of
psychiatry were intricately and intimately linked. Mad-doctors (as their
critics persisted in calling them), or alienists (as they understandably
preferred to call themselves), insisted that the physical structures that
contained their patients were a central part of the effort to treat mental
illness, and that no one knew better than they did how to design these
institutions. Led by Thomas Story Kirkbride, superintendent of the private
Pennsylvania Hospital for the Insane, they linked their claims to expertise
and therapeutic prowess directly to the details of hospital design. And it
was from their positions at the head of these institutions that the
alienists derived their patients, their incomes and their cultural
authority.
There were a tiny handful of colonial precedents for locking up the mad. The
English had their famous establishments – Robert Hooke’s ornate new Bethlem,
or Bedlam, which dated from 1676, and its much plainer metropolitan rival
from the second half of the eighteenth century, St Luke’s Lunatic Hospital.
Usually, though, these precedents had little influence on the American
colonists. Their first place of confinement for the insane was in the
basement of Benjamin Franklin’s Pennsylvania Hospital, most of whose
accommodation was devoted to the physically ill. To be sure, the Virginia
burgesses, at the urging of their colonial governor, Francis Fauquier, built
their own Bedlam or madhouse, but for the most part, it was not until the
nineteenth century that Americans embarked on a serious programme of
building specially designed asylums, and when they did so, as in the mother
country from which they had now violently separated themselves, Bethlem
served as a bad example, not a model.
Another English institution, the famous Quaker establishment called the York
Retreat, had served as the inspiration for a first generation of reformed
asylums in the nineteenth-century United States. Yanni usefully traces its
influence, and the subtle modifications that were made to the original
building when Americans adapted the plans to the New World. The Retreat
adopted an essentially domestic, small-scale architecture, one that directed
much attention to the effects of spatial arrangements and aesthetics on
patients’ sensibilities, and to the use of the built environment to modify
human behaviour. It is hard to recall, in the light of the mammoth asylums
that became general in the second half of the nineteenth century, and the
associated collapse of all sense of therapeutic optimism, that the asylum
was at the outset a utopian institution, one which, its founders were
convinced, could serve as a forcing house for change, allowing the
reinvention of the disturbed and delusional as paragons of self-controlled,
conventional behaviour. Such expectations were, of course, themselves
delusions.
Using floor plans, elevations, pictures of hospital wards and interiors, Yanni
reconstructs the distortions and then the demise of these early visions of
curative asylums. Her book is full of powerful images. Nineteenth-century
asylums very frequently produced postcards, some of their exteriors, others
of their grounds and of wards. And there exist a handful of eccentrics who
have made a hobby of collecting these artefacts, preserving images that
would otherwise have vanished alongside the buildings and the in-patients
they memorialize. Drawing on these pictures, and wide-ranging and meticulous
work in the archives, as well as some of her own photography, Yanni has
constructed a remarkable volume.
From the space for thirty inmates that characterized the York Retreat, later
asylums transformed themselves into establishments with their own gas works,
reservoirs, chapels, farms, graveyards and rooms for, first hundreds and
then thousands of unfortunates. Visually and verbally, Yanni dissects the
hegemony and then the decay of what was once the standard design of the
American mental hospital, the so-called Kirkbride or linear plan. One
typically creative idea is her decision to redraw the outlines of a series
of hospitals built on these principles, from the colonial asylum at
Williamsburg, Virginia (1770), to the State Hospital designed by the master
architect H. H. Richardson at Buffalo, New York (1870). Drawn to scale, this
series of plans vividly drives home the massive expansion of the size of
mental hospitals that occurred in the course of a century.
Subsequently, Yanni looks at the displacement of the linear form by the
“cottage plan”, an architectural shift to a series of buildings (often each
containing 200 or 300 patients) gathered round a central administrative
core. Taking the place of the previous plan of a single long building in the
shape of a shallow “V”, the congregate system, as it was also called, was an
innovation that allowed the construction of still larger asylums. Here were
extraordinary complexes of buildings superficially resembling sizeable
towns, some designed to hold as many as ten or twelve thousand inhabitants.
“Community care” this was not, for those confined in these wards
continued to be rigorously excluded from the larger society.
In her concluding chapter, Yanni looks to the fate of these establishments in
a modern world that has lost faith in institutional care. The stigma that
attaches to asylums has often limited their attractions to redevelopers.
Making matters worse, certain structural features of the buildings have
often made it exceedingly difficult to adapt them to other purposes. Many
contained large numbers of single cells, often divided up by thick,
load-bearing walls, making modifications expensive or impossible. Large
numbers of state hospitals have therefore been torn down, in whole or in
part. Others stand deserted, slowly decaying, the unmourned residue of
bygone enthusiasms. In Utica, for instance, the stunning Greek Revival New
York State Hospital sits empty with trees growing from the sediment on its
roof.
In a nice bit of historical irony, the old asylum at Colonial Williamsburg has
been reconstructed, and now forms part of the dramatization of
eighteenth-century life at that tourist attraction. Meantime, as Yanni
plaintively acknowledges, “the final architectural setting for a
welfare-dependent schizophrenic or manic-depressive, after
institutionalization, was not a building, it was the street”.
Andrew Scull has written extensively on the history of psychiatry from the
eighteenth through to the twentieth century. His book Madhouse: A tragic
tale of megalomania and modern medicine appeared in a new paperback edition
last month.
