Book Review: The Architecture of Madness

The Architecture of Madness: Insane Asylums in the United States by Carla Yanni

In the United States today, insane asylums could be said to be revered more by urban explorers, and those with a penchant for ruins, than architects and architectural historians. But one look at the massive edifices sitting on acres of land, and it is apparent that much went into the construction of these facilities, much that needs to be addressed. Carla Yanni's book fills the gap in knowing why these asylums came about, why they look the way they do, and why they disappeared or were abandoned. While previous books have addressed the first and last considerations, they tended to ignore the physical aspects of the buildings, and the author's main contention is that the architecture cannot be separated from the treatment of the patients: they are linked strongly, to the extent that many of these buildings cannot be renovated to other uses as their designs were so particular to their cause.

A professor of art history, Yanni's very readable (i.e. non-academic) text starts in the 18th-century, with the establishment of dedicated facilities for the treatment of the insane, and ends in the current decade with the Clubhouse model, though the majority of the book focuses on the 19th century, specifically mid-century when the Kirkbride plan dominated the shape of the Victorian asylum. Simply put, psychiatrist Thomas Kirkbride believed that the treatment of the insane could not be facilitated at home, a typical hospital, or any other facility, so he developed what is known as the linear plan, though in effect it is a stepped series of long, single- or double-loaded corridors (à la the red insignia on the book's cover) that separated men and women in separate wings and isolated the most severe cases in detached structures most removed from the central administrative area. This inefficient, potentially ever-growing footprint required a lot of land, something that meshed with the belief at the time that mental treatment is best achieved in close contact with nature, not the city. Therefore most of these 19th-century edifices are removed from not only urban cores but the families of patients.

What is perhaps most fascinating about Yanni's architectural-social study of these asylums is how they addressed the home and family, from their role in causing mental problems and thereafter aiding in (or staying out of) treatment to their impact on the architecture of the buildings, especially the interiors. For example, Kirkbride's plan gave each patient a room, small to be sure, but with a window and privacy, the last in many cases something the patient might not have had at home. Within this lies a paradox: replicating certain aspects of the home while feeling the need to remove the individual from it for competent and total treatment, as if the home or the family were the primary source of the mental malady and would be a continuing strain on the insane.

These considerations never received full resolve in Kirkbride's and other's models, as 20th-century science and medicine eventually made mental illness treatable via prescription drugs and psychiatric sessions, replacing the need for large-scale hospitals and their impressive architecture. The uneasy relationship between the home and the mentally-ill state of mind still lingers in the Clubhouse model, though, an outpost that gives people somewhere to go besides home, therefore speeding up their recovery. While the Clubhouses are far removed architecturally from the Victorian asylums -- the latter grandly designed in neo-stylistic flourishes that bordered on the civic or religious and the former low-key urban infill or renovation projects -- this and other aspects linger, making that strong link between the architecture and the treatment ongoing, if diminished in scope and scale.