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.

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