Kirkbride Plan Explained

The Kirkbride Plan was a system of mental asylum design advocated by American psychiatrist Thomas Story Kirkbride (1809–1883) in the mid-19th century. The asylums built in the Kirkbride design, often referred to as Kirkbride Buildings (or simply Kirkbrides), were constructed during the mid-to-late-19th century in the United States.

The structural features of the hospitals as designated by Kirkbride were contingent on his theories regarding the healing of the mentally ill, in which environment and exposure to natural light and air circulation were crucial. The hospitals built according to the Kirkbride Plan would adopt various architectural styles, but had in common the "bat wing" style floor plan, housing numerous wings that sprawl outward from the center.^[1]

The first hospital designed under the Kirkbride Plan was the Trenton State Hospital in Trenton, New Jersey by John Notman, constructed in 1848. Throughout the remainder of the nineteenth century, numerous psychiatric hospitals were designed under the Kirkbride Plan across the United States. By the twentieth century, popularity of the design had waned, largely due to the economic pressures of maintaining the immense facilities, as well as contestation of Kirkbride's theories amongst the medical community.

Numerous Kirkbride structures still exist, though many have been demolished or partially-demolished and repurposed.

At least 30 of the original Kirkbride buildings have been registered with the National Register of Historic Places in the United States, either directly or through their location on hospital campuses or in historic districts.

History

Basis and philosophy

The establishment of state mental hospitals in the U.S. is partly due to reformer Dorothea Dix, who testified to the New Jersey legislature in 1844, vividly describing the state's treatment of lunatics; they were being housed in county jails, private homes, and the basements of public buildings. Dix's effort led to the construction of the New Jersey State Lunatic Asylum, the first complete asylum built on the Kirkbride Plan.

Thomas Story Kirkbride (1809–1883), a psychiatrist from Philadelphia, Pennsylvania, developed his requirements of asylum design based on a philosophy of Moral Treatment and environmental determinism.^[2] The typical floor plan, with long rambling wings arranged en echelon (staggered, so each connected wing received sunlight and fresh air), was meant to promote privacy and comfort for patients. The building form itself was meant to have a curative effect, "a special apparatus for the care of lunacy, [whose grounds should be] highly improved and tastefully ornamented." The idea of institutionalization was thus central to Kirkbride's plan for effectively treating the insane.

Design and architectural features

The Kirkbride Plan asylums tended to be large, imposing institutional buildings,^[3] with the defining feature being their "narrow, stepped, linear building footprint" featuring staggered wings extending outward from the center, resembling the wingspan of a bat. The standard number of wings for a Kirkbride Plan hospital was eight, with an accommodation of 250 patients. Kirkbride's philosophy behind the staggered wings was to allow individual corridors open to sunlight and air ventilation through both ends, which he believed aided in healing the mentally ill. Each wing, according to Kirkbride's original guidelines, would house a separate ward, which would contain its own "comfortably furnished" parlor, bathroom, clothes room, and infirmary, as well as a speaking tube and dumbwaiter to allow open communication and movement of materials between floors. The wings furthest from the center complex of the building were reserved for the "most excitable," or most physically dangerous and volatile patients. Patient rooms were suggested to be spacious, with ceilings "at least 12feet high," but only large enough to room a single person. The center complexes of the Kirkbride Plan buildings were designed to house administration, kitchens, public and reception areas, and apartments for the superintendent's family. Architectural styles of Kirkbride Plan buildings varied depending on the appointed architect, and ranged from Richardsonian Romanesque to Neo-Gothic.

In addition to the intricate building design, Kirkbride also advocated the importance of "fertile" and spacious landscapes on which the hospitals would be built, with views that "if possible, should exhibit life in its active forms." Kirkbride also suggested the hospital grounds be a minimum of in size. The foliage and farmlands on the hospital grounds were sometimes maintained by patients as part of physical exercise and/or therapy. Over the course of the nineteenth and twentieth centuries, the campuses of these hospitals often evolved into sprawling, expansive grounds with numerous buildings.

Operations and staffing

Salaries per annum (1854)
Position	Compensation (USD)
Physician-in-chief	$1,500–2,500
Assisting physicians	$300–$500 + board
Steward	$500
Supervisors	$175–250
Engineer	$240
Carpenter	$240
Teachers	$175–200
Carriage driver	$168
Farmers & gardeners	$144–200
Attendants	$108–168
Cooks & bakers	$100–150
Nightwatchmen	$108
Seamstresses	$96

In his proposal, Kirkbride outlined specific guidelines as to how a Kirkbride Plan hospital should be staffed and operate on a daily basis. Kirkbride suggested a total of 71, all of whom were required to live within, or in the immediate vicinity of, the hospital. The superintending physician, or physician-in-chief, was required to live in the main hospital or in a building contiguous to it, while his family had the option of residing at the hospital or seeking private lodging. The staff was also to have a balanced gender distribution, with approximately 36 female and 35 male staff members.

Among the staff of a Kirkbride Plan hospital were the superintending physician, an assisting physician and nurses, supervisors and teachers of each sex, a chaplain, matron, and a nightwatchman. Kirkbride urged that at least two attendants be working in each ward at any given time, and stressed the importance of the superintendent's "proper selection" of attendants, given the extent of their management responsibilities: "The duties of attendants, when faithfully performed, are often harassing, and in many wards, among excited patients, are peculiarly so. On this account pains should always be taken to give them a reasonable amount of relaxation and their position should, in every respect, be made as comfortable as possible." For general labor at the hospital, he suggested that the able-minded patients help maintain the hospital grounds and assist in duties in their respective wards.

Kirkbride's estimation of the number of staff as well as their respective compensations was outlined in an 1854 publication on the Kirkbride Plan design. He proposed a living wage for all employees of the hospital, noting that "although in a few institutions a liberal compensation is given, in many, the salaries are quite too low, and entirely inadequate to be depended on, to secure and retain the best kind of talent for the different positions. The services required about the insane, when faithfully performed, are peculiarly trying to the mental and physical powers of any individual, and ought to be liberally paid for." Salary for the superintending physician according to the 1854 guideline was to be USD$1,500 if the physician's family resided at the hospital, and $2,500 if they found lodging at a private residence. In addition to the medical staff and attendants, the Kirkbride Plan hospitals also employed laborers of various trades, including resident engineers, carpenters, cooks and dairymaids, gardeners, seamstresses, ironworkers, clothing launderers, and a carriage driver.

Decline and phasing out

By the late nineteenth century, the Kirkbride design had begun to wane in popularity, largely because the hospitals, which were state-funded, had received significant budget cuts that rendered them difficult to maintain. General psychiatric and medical opinion of Kirkbride's theories regarding the "curability" of mental illness were also questioned by the medical community.

Future

Status

A total of 73 known Kirkbride Plan hospitals were constructed throughout the United States between 1845 and 1910. As of 2016, approximately 33 of these identified Kirkbride Plan hospital buildings still exist in their original form to some degree: 24 have been preserved indicating that the building is still standing and still in use, at least, in part. 11 of the 24 preserved properties received secondary condition codes of deteriorating, vacant, partial demolition or a combination, while the remaining nine have been adaptively reused. Of the 40 hospital buildings that no longer exist (either via demolition or destruction from natural occurrences, such as earthquakes), 26 were demolished to be replaced with new facilities.

The highest concentrations of Kirkbride Plan hospitals were in the Northeast and Midwestern states. Fewer Kirkbride Plan hospitals were constructed on the West Coast: In California, the Napa State Hospital was a notable Kirkbride Plan hospital, though the original structure was severely damaged during the 1906 San Francisco earthquake, and was ultimately demolished. The two surviving Kirkbride structures on the West Coast are both located in the state of Oregon, at the Oregon State Hospital, and the Eastern Oregon State Hospital, the latter of which now houses the Eastern Oregon Correctional Institution.^[4] While the vast majority of Kirkbride hospitals were located in the United States, similar facilities were built in Canada, and the Callan Park Hospital for the Insane in Sydney, Australia (constructed in 1885) was also influenced by Kirkbride's design.

Preservation efforts

Due to their intricate architectural features and historical significance, Kirkbride Plan hospitals have attracted conservation efforts from local and national groups, and (as of 2016) approximately 30 of the buildings have been registered with National Register of Historic Places. Local conservation groups and historical societies have made attempts to save numerous Kirkbrides from demolition: The Danvers State Hospital in Danvers, Massachusetts is one example, in which a local historical society filed a lawsuit in 2005 to stall demolition of the building.^[5] The majority of the Danvers State Hospital was demolished in 2007 spite of the lawsuit, with only the center portion of the building receiving restoration and conversion into apartments.^[5] The Northampton State Hospital in Northampton, Massachusetts, was demolished in 2006.^[6]

Many of the surviving Kirkbride Plan buildings in the United States have undergone at least partial demolition and have been repurposed, often with the center portions of the buildings being most commonly preserved. The center complexes of the Hudson River State Hospital^[7] in Poughkeepsie, New York, and the Oregon State Hospital in Salem, Oregon, for example, have been retained in spite of the majority of the outermost wings being demolished. One such Kirkbride Plan facility that has survived in its entirety is the Trans-Allegheny Lunatic Asylum, though does not contemporarily function as an active hospital. As of 2023, Trans-Allegheny Lunatic Asylum has not undergone demolition.^[8]

Several facilities originally established as Kirkbride Plan hospitals are still active in the 21st century, though not all have retained the original Kirkbride buildings on their campuses. The Oregon State Hospital, the longest continuously operated psychiatric hospital on the West Coast, retained the majority of its original Kirkbride building during a 2008 demolition, seismically retrofitting and repurposing it as a mental health museum in 2013.

Notable Kirkbride hospitals

United States

Built	Name	Location	Status	Notes	NRHP #
1848		Trenton, New Jersey	Active	The first Kirkbride Plan building		style=text-align:center
1848	Central State Hospital		Inactive	One Kirkbride building, the Department for Women (1878), demolished 1970s		style=text-align:center	^[9]
1848			Inactive	Original Kirkbride building demolished 1970	75000669	style=text-align:center
1851			Inactive	Original Kirkbride building demolished 1893	86000057	style=text-align:center
1853			Demolished 2009		93001484	style=text-align:Center
1854			Active	Destroyed by fire in 1861; interiors rebuilt	79003612	style=text-align:center
1854–66	Maine Insane Hospital	Augusta, Maine	Inactive	Original construction was not a Kirkbride; however, it was converted between 1854 and 1866	82000754	style=text-align:center
1855	Jackson State Hospital	Jackson, Mississippi	Inactive	Original Kirkbride building demolished; campus now houses University of Mississippi Medical Center		style=text-align:center
1855			Inactive	Repurposed as assisted living facility	79001902	style=text-align:center	^[10]
1855	St. Elizabeths Hospital		Active	Kirkbride now serves as DHS HQ	79003101	style=text-align:center	^[11] ^[12]
1856			Active	Original Kirkbride building houses administrative offices	87002115	style=text-align:center	^[13]
1858			Demolished 2006		94000696	style=text-align:center
1858	Mendota Mental Health Institute	Madison, Wisconsin	Active	Original Kirkbride building demolished 1964		style=text-align:center	^[14]
1859		Philadelphia, Pennsylvania	Inactive		66000684	style=text-align:center	^[15]
1859			Inactive	Original Kirkbride building demolished		style=text-align:center
1859			Inactive	Sold to the adjacent University of Alabama and partially demolished (main part saved)	77000216	style=text-align:center
1862			Demolished 2005		80003401	style=text-align:center	^[16]
1863			Inactive	Formerly known as Weston State Hospital	78002805	style=text-align:center
1865			Destroyed 1936	Original Kirkbride building destroyed in fire		style=text-align:center
1866	St. Peter State Hospital (now Minnesota Security Hospital)	St. Peter, Minnesota	Active	Majority of original Kirkbride building demolished		style=text-align:center
1866	Willard State Hospital	Seneca, New York	Active	Comprised four separate Kirkbride buildings, one of which was demolished 1980	75001229
1868		Poughkeepsie, New York	Inactive	Undergoing demolition as of 2016; portion of original Kirkbride building preserved	89001166	style=text-align:center	^[17]
1868	Osawatomie State Hospital	Osawatomie, Kansas	Active	Original Kirkbride building demolished between 1971 and 2002
1869			Inactive	Administration section of original Kirkbride building remains and is in use		style=text-align:center
1869			Demolished 1996		83002646	style=text-align:center
1869		Danville, Pennsylvania	Active	Original Kirkbride building preserved and in use		style=text-align:center	^[18]
1870	Central State Hospital	Petersburg, Virginia	Active	Original Kirkbride building demolished		style=text-align:center
1870			Inactive	Original Kirkbride building restored and subdivided by State of New York for public use	73001186	style=text-align:center
1872			Demolished 1963			style=text-align:center	^[19]
1872		Elgin, Illinois	Active	Original Kirkbride building demolished 1993		style=text-align:center	^[20]
1872	Topeka State Hospital	Topeka, Kansas	Demolished 2010			style=text-align:center
1873			Active	Original Kirkbride demolished in stages between 1950 and 1969		style=text-align:center
1873	Independence State Hospital		Active			style=text-align:center
1874			Inactive	Renovated and repurposed by Ohio University	80002936	style=text-align:center	^[21]
1874		Warren, Pennsylvania	Active			style=text-align:center	^[22]
1876	Greystone Park Psychiatric Hospital		Active	Original Kirkbride building demolished 2015		style=text-align:center	^[23]
1876			Active	Original Kirkbride building demolished 1949		style=text-align:center	^[24]
1877	Columbus State Hospital	Columbus, Ohio	Demolished 1991			style=text-align:center	^[25]
1877			Active	demolished	80000530	style=text-align:center
1878			Demolished 2006	Center exterior of Kirkbride building preserved	84002436	style=text-align:center
1878			Demolished 2000		81000315	style=text-align:center
1879			Active	Original Kirkbride building preserved		style=text-align:center
1883			Active	Original Kirkbride building repurposed as mental health museum	08000118	style=text-align:center
1883	Broughton Hospital	Morganton, North Carolina	Active		77000996
1883	Arkansas State Hospital		Active	Kirkbride building demolished 1963		style=text-align:center	^[26] ^[27]
1884		Clarinda, Iowa	Inactive			style=text-align:center
1885			Inactive	Center of main building demolished and replaced in 1963, remainder renovated and in use as condos and businesses	78001499	style=text-align:center
1885			Inactive	Original Kirkbride building destroyed in 1906 earthquake; partially rebuilt in 1910	97000829	style=text-align:center
1885	Terrell State Hospital	Terrell, Texas	Active	Original Kirkbride building demolished		style=text-align:center
1887	Nevada State Hospital	Nevada, Missouri	Demolished 1999			style=text-align:Center
1890	Cherokee Mental Health Institute		Active			style=text-align:center
1891			Active		71000369	style=text-align:center
1891			Active	Original Kirkbride building demolished		style=text-align:center	^[28]
1892			Active	Originally Named Southwestern Insane Asylum until 1925. Original Kirkbride building demolished and replaced in the 1970's		style=text-align:center	^[29]
1893	Patton State Hospital	San Bernardino, California	Active	Original Kirkbride building demolished		style=text-align:center
1894	St. Vincent's Hospital	Normandy, Missouri	Inactive	Original Kirkbride building repurposed as apartment building	82004722
1895			Inactive		86001386	style=text-align:center	^[30]
1913	Eastern Oregon State Hospital	Pendleton, Oregon	Inactive	Houses Eastern Oregon Correctional Institution as of 1983		style=text-align:center

Outside the United States

Built	Name	Location	Status	Notes
1858	Nova Scotia Hospital	Halifax, Nova Scotia, Canada	Active	Original Kirkbride building demolished 1996	style=text-align:center
1885	Callan Park Hospital for the Insane	Lilyfield, New South Wales, Australia	Inactive	Original Kirkbride building preserved; campus houses Sydney College of the Arts	style=text-align:center	^[31]

In popular culture

Numerous Kirkbride Plan hospitals and buildings have been featured in the arts: the Danvers State Hospital in Danvers, Massachusetts was both the setting and primary filming location for the 2001 psychological horror film Session 9.^[5] It has also been suggested by historians as an inspiration on H. P. Lovecraft, and in turn an inspiration for the fictional setting Arkham Asylum in the various Batman series.^[32] The Oregon State Hospital was also featured as the primary filming location for the film One Flew Over the Cuckoo's Nest (1975),^[33] and was also the setting of "Ward 81," a 1976 series of photographs by photographer Mary Ellen Mark.

The Trans-Allegheny Lunatic Asylum in West Virginia was featured on the Travel Channel reality series Ghost Adventures.^[34]

References

See Yanni, The Architecture of Madness, introduction, for more on environmental determinism.

Works cited

• Book: Goeres-Gardner, Diane L.. Inside Oregon State Hospital: A History of Tragedy and Triumph . The History Press. 2013 . 978-1-62619-040-5.
• Hoopes. Lauren. On the Periphery: A Survey of Nineteenth-Century Asylums in the United States. Clemson University. May 2015.
• Book: The Institutional Care of the Insane in the United States and Canada. Google Books. 2. 434. Johns Hopkins Press. 1916. Hurd. Henry Mills. 9780405052101.
• Book: Kirkbride, Thomas Story. Thomas Story Kirkbride. On the Construction, Organization, and General Arrangements of Hospitals for the Insane. kirkbride.. Lindsay & Blakiston. 1854. Internet Archive.
• Murphy. Mardita M.. 2016. University of North Carolina, Greensboro. Preserving the Kirkbride Legacy: An Analysis of the Extant State of the Plan and Challenges of Adaptive Reuse.
• Book: Verderber, Stephen. 2010. Innovations in Hospital Architecture. Routledge. 978-0-415-77795-7.
• Book: Yanni, Carla. The Architecture of Madness: Insane Asylums in the United States . Minnesota University Press. 2007. 978-0-8166-4940-2 .

Further reading

• Book: Tomes, Nancy. The Art of Asylum-Keeping: Thomas Story Kirkbride and the Origins of American Psychiatry. 1994. University of Pennsylvania Press. 978-0-8122-1539-7.

External links

Historical resources

• The Kirkbride Plan history at the Social Welfare History Project
  • The Kirkbride Plan at the Restoring Perspective project, Western University Kirkbride Buildings.com - historical archive with photos
• Historic Asylums via Rootsweb

Photo and videography

• Kirkrbride Plan Photography at Opacity
• Kirkbrides HD videography

Notes and References

1. Web site: About Kirkbride Buildings. Kirkbride Buildings. May 9, 2017.
2. Web site: Therapeutic Architecture . The Pennsylvania Center of the Book. Harvilla, Lindsay. 2010. May 12, 2017.
3. Web site: The Buildings. Kirkbride Buildings. May 9, 2017.
4. Web site: Century-old Pendleton mental health hospital prepares to shut down. The Bend Bulletin. Aney, Kathy. February 18, 2014. May 10, 2017.
5. Web site: Bad News for Danvers State Hospital. Salem News. Opacity. November 9, 2005. Cassidy, Chris. May 10, 2017.
6. Web site: Northampton State hospital's history shared in images. The Republican. MassLive. November 26, 2014. May 10, 2017.
7. Web site: The Lovely Bones: Renovating the Kirkbride Asylums Means Finding New Ways to Live With Old Ghosts. The Village Voice. Penny, Daniel. April 6, 2016. May 12, 2017.
8. Web site: Trans-Allegheny Lunatic Asylum – Historic and Paranormal Tours.
9. Web site: Inside Indy's 'insane asylum'. Indianapolis Recorded. September 24, 2015. Davis, Victoria T.. May 9, 2017.
10. Web site: Dayton State Hospital. Dayton Daily News Archive . Wright State University. May 11, 2017. Rickey, Lisa. October 22, 2013.
11. Web site: St. Elizabeths Hospital. Kirkbride Buildings. May 10, 2017.
12. Web site: Finding Asylum: Tracing the evolution of five Kirkbride Planned hospitals for the insane. The Architects Newspaper. October 30, 2015. May 12, 2017. Moerson, Maria Elena.
13. Web site: History of the Austin State Hospital. Texas Department of State Health Services. May 10, 2017.
14. Book: Public Documents of the State of Wisconsin . Wisconsin Laws, Statutes, etc . 1858. Google Books.
15. Web site: Pennsylvania Hospital History. University of Pennsylvania. History of Pennsylvania Hospital. May 9, 2017.
16. Web site: From the archives: Kirkbride buildings, built to foster sanity, now empty hulks. NJ.com. May 31, 2015. Hochman, Louis C.. May 10, 2017.
17. Web site: Ground broken for development at former Hudson River Psychiatric Center. Hudson Valley One. Horrigan, Jeremiah. July 28, 2016. May 9, 2017.
18. Web site: Timeline of the Hospital. Danville State Hospital. Thomas Industries. May 10, 2017.
19. Web site: Spring Grove History. Maryland Department of Health and Mental Hygiene . May 9, 2017.
20. Book: The History of Elgin Mental Health Center: Evolution of a State Hospital . Briska, William H. . Crossroads Communications . 1997 . 0-916445-45-3.
21. Web site: Old Athens insane asylum to get new life as part of Ohio University . The Columbus Dispatch. October 15, 2015. May 10, 2017. Riely, Logan .
22. Web site: Warren State Hospital. June 7, 2007 . dead . https://web.archive.org/web/20070426064700/http://www.dpw.state.pa.us/Family/MentalHealthServ/StateMentalHospAndRest/003670893.htm . April 26, 2007. Pennsylvania Department of Public Welfare .
23. Web site: Greystone: History reduced to rubble. Daily Record. Westhoven, William. May 15, 2015. May 9, 2017.
24. Web site: At 130 years, Napa State Hospital is leading reforms in mental health. Napa Valley Register. Ryan, David. December 2, 2005. May 10, 2017.
25. Web site: Columbus State Hospital. Ohio State University Library. September 26, 2011. May 9, 2017.
26. Encyclopedia: Arkansas State Hospital. Encyclopedia of Arkansas. May 9, 2017. Goff, April.
27. Web site: Arkansas Lunatic Asylum – Arkansas's Forgotten Asylum. March 2, 2021.
28. Web site: Eastern State Hospital. Spokesman-Review. July 4, 2016. May 10, 2017.
29. Web site: San Antonio State Hospital. Texas-State-Historical-Association. 1976. February 10, 2021. April 20, 2024.
30. Web site: The Fergus Falls Journal. Kirkbride Building tour prepares officials. October 18, 2016. Engstrom, Tim. May 10, 2017.
31. Web site: Kirkbride: Past & Present. Sydney College of the Arts. University of Sydney. August 2005. May 11, 2017.
32. Book: Cinema's Sinister Psychiatrists: From Caligari to Hannibal. Packer, Sharon. McFarland. 208. 2012. 978-0-786-49241-1.
33. Web site: Once a 'Cuckoo's Nest,' Now a Museum. The New York Times. March 31, 2013. May 7, 2017. Johnson, Kirk.
34. Web site: Ghost Adventures: Trans Allegheny Lunatic Asylum. The Travel Channel. May 11, 2017.