of Madness: Insane Asylums in the United
University of Minnesota Press, Minneapolis,
256 pp., illus, 120 b/w. Trade, $82.50;
ISBN: 0-8166-4939-1; ISBN: 0-8166-4940-5.
Reviewed by John F. Barber
Digital Technology and Culture, Washington
State University Vancouver
Nineteenth-century doctors did not agree
on the nature or causes of insanity. They
did, however, agree that much of the insanity
exhibited by Americans of that time was
curable with the help of specially designed
buildings. The Architecture of Madness
is, at its heart, an exploration of the
architecture for the care and treatment
of insane persons during the nineteenth
More than simply a history of buildings,
however, this new book by Carla Yanni,
associate professor of art history at
Rutgers University, demonstrates how ideas
regarding the therapeutic values of architecture
were closely connected to changing social
and medical paradigms.
Socially, the number of insane asylums
increased in the nineteenth century. Scholars
of the history of psychiatry point to
several reasons. First, the geographical
separation between the workplace and home
created splintered, smaller, specialized
families that undermined the ability to
care for needy members. Healthy individuals,
who needed to work for a living, increasingly
sought help from paid care-givers or the
state for family members stricken with
insanity, thus creating a new market economy.
More fundamentally, the presence of an
insane relative threatened the nuclear
family and the sanctity of the home, both
central components of the Victorian era
Both families and doctors faced a paradox
when it came to committing relatives,
however. Insane asylums were not seen
as the sort of place to send a family
member, especially with the general conception
of insane asylums as large, unwelcoming,
cold and dark, their residents sitting
unclothed, shivering on dirty floors,
shackled to the walls.
Dr. Thomas S. Kirkbride, a Philadelphia
Quaker, believed good architecture was
essential for the treatment and recovery
of lunatics, and it was his "linear plan,"
short but connected pavilions arrayed
in a shallow V, that dominated the architecture
and building of insane asylums from 1840
to about 1880. These buildings, built
in styles to mimic Greek temples, classical
cathedrals, and Arts and Crafts cottages,
attempted to communicate a message of
generosity, civic munificence, and kindness
to those less fortunate.
Coupled with ideas regarding the importance
of proper ventilation, the benefits of
outdoor activities, and restful landscaping,
these insane asylums, most often located
on the outskirts of cities, attempted
to provide a refuge from the stress and
turmoil of urbanization.
The Architecture of Madness tracks
these parallel histories through a series
of tightly conceived chapters. The first
chapter introduces the Victorian understanding
of moral management as a treatment for
the insane by which diverting activities
such as walking, boat trips, acting in
skits, and sleigh rides were meant to
inculcate patients with self control and
positive thoughts, all part of the cure
for insanity, and all part of the internal
culture of an asylum.
Chapter 2 focuses on Kirkbride's "linear
plan" and its development in several asylums
throughout the United States to about
1880. In addition to the architectural
design, described above, Kirkbride advocated
segregating patients by severity of illness,
ease of treatment and surveillance, and
ventilation. These factors were purpose
built into many of the structures following
Chapter 3 presents alternatives to the
linear plan. Interestingly enough, however,
these alternatives were not so much focused
on buildings, either large or small, but
rather on medical treatments and moral
management, which, although different,
still claimed the same beneficial results.
In the second half of the Nineteenth Century,
following the American Civil War, insane
asylums exploded in numbers and in size.
The average number of inhabitants increased
from 250 to 600. Larger asylums were built
to accommodate them. Chapter 4 deals with
these grand institutions.
Additionally, asylums established on principles
of architectural environment fell into
disfavor in the 1890s when neurologists
mocked asylum doctors for their lack of
scientific research. By century's end
many asylums had become human warehouses,
exactly an outcome Kirkbride had argued
In the end, Yanni's point is well made:
Nineteenth Century doctors believed architecture
was part of the cure for insane persons
thought likely to improve, and part of
the treatment for those chronically ill.
In either case, treatment of the insane
was conducted not only in, but by, the
By 1900, the focus on the therapeutic
value of architecture and environment
was no longer a key goal of asylum managers.
Their buildings were crowded with those
still unwell, despite 60 years of treatment.
The psychiatric profession needed to disassociate
itself from the claims of environmental
determinism since, obviously, the environment
(including the architecture of the asylums
themselves) had not determined many cures
More and more frequently through the Twentieth
Century patients suffering from insanity
were proscribed outpatient care. Today,
the severely mentally ill are all but
invisible, sequestered in state hospitals.
And, as treatment emphasis has shifted
to milder, non-institutionalized cases
of mental illness, architecture has declined
in importance to the field of psychiatry.
While it was at the forefront of treatment
for mental illness, architecture was,
as Yanni explains, deeply intertwined
with then prevalent social, intellectual,
and medical currents.
The Architecture of Madness tells
the story of this intertwining in a fresh
and original way.