The village of Athens celebrated the laying of the cornerstone of its asylum with a parade of nearly ten thousand persons. The new institution coming to town was of great economic and political importance to its residents, who staged an enormous celebration. On Thursday, November 5, 1868, at two o’clock in the afternoon, one thousand Masons from all over Ohio, a brass band, two church choirs, judges, the mayor of Athens, the village council, hundreds of townspeople, and thousands of supporters from other areas marched down a long hill across the old South Bridge spanning the Hockhocking River9 and up the great hill to the asylum grounds.10 Ohio’s fifth state-supported asylum to treat persons with mental illness was to be a Kirkbride hospital, the gold standard for Victorian-era mental hospitals. Kirkbride hospitals were built to the most rigorous specifications of moral treatment, the prevailing psychiatric treatment of the time.
The Kirkbride Plan
Dr. Thomas Kirkbride’s interpretation of moral treatment, developed at the Pennsylvania Hospital for the Insane, was the crown jewel of nineteenth-century American psychiatry.11 He proposed that mental illness was curable, that physical punishment and restraints should be abolished, that treatment of those with mental illness as though they were capable of rational behavior was curative, and that a system of routines and diversions in a restful and supportive setting was therapeutic. Dr. Philippe Pinel, physician for two asylums in Paris, touched off the moral treatment movement in 1795 when he allegedly removed chains from his patients and undertook humane, compassionate, and supportive care. He dubbed his method traitement morale, meaning ethical, honorable treatment. This approach was a radical alternative to well-established aggressive, punitive tactics of curing mental illness with punishment and restraints. A year later, in 1796, William Tuke, a Quaker tea merchant, opened the York Retreat for persons with mental illness, using kindness, reason, and a family atmosphere rather than the medical treatments of the time.12
Nineteenth-century asylum physicians dedicated to moral treatment believed that mental illness was curable through proper habits and a regular, healthy life. Dr. William H. Holden, superintendent of the Athens Lunatic Asylum, described moral treatment in his 1879 annual report to the Board of Trustees:
Under the head of moral treatment must be considered all those means that tend to lead the mind into a normal and healthy channel, and direct the thoughts, as much as possible, in another course, remote from their delusions. See your patients frequently; talk to them, give them kind words and pleasant looks; encourage them as much as possible. Give them moderate exercise. Walking, riding, and driving in the open air have a tendency to break the monotony of asylum life and add to the comfort and happiness of the patient. Voluntary exercise is indicative of improvement and should be encouraged. Occupation engrosses the mind and withdraws it from empty longings and illusions of the imagination.13
Psychiatry placed great faith in the curative possibilities offered by the physical setting and social influences of the asylum; indeed, a Kirkbride hospital is a visual and architectural record of nineteenth-century psychiatry’s tenets. Kirkbride’s guidelines for the construction and operation of hospitals for the insane were adopted in 1851 by the Association of Medical Superintendents of American Institutions for the Insane.14 The guidelines, almost unimaginable by today’s standards of inpatient care for persons with mental illness, were devoted to the landscape and the design and construction of the building. Nearly eighty asylums were built in America to the specifications of the Kirkbride plan, most of them between 1848 and 1890. From Taunton State Hospital (completed in 1854) in Massachusetts, Jackson State Hospital (1855) in Mississippi, Mendota State Hospital (1860) in Wisconsin, Dixmont State Hospital (1852) in Pennsylvania, Worcester State Hospital (1877) in Massachusetts, Napa State Hospital (1875) in California, and Terrell State Hospital (1885) in Texas to Traverse City State Hospital (1885) in Michigan, states embarked on construction of Kirkbride asylums on a massive scale.15
Dr. Kirkbride suggested that hospitals should be located in the country and have at least fifty acres devoted to gardens and pleasure grounds for patients with at least another fifty acres for farming and other uses. “The building should be in a healthful, pleasant, and fertile district of the country; the land chosen should be of good quality and easily tilled; the surrounding scenery should be varied and attractive, and the neighborhood should possess numerous objects of an agreeable and interesting character.”16 To bring light and cheer to each wing of the hospital, each floor should have an atrium with plants, birds and fountains:
Leaving on each side (of each wing) an open space of ten or twelve feet, with movable glazed sash extending from near the floor to the ceiling, and which may either be accessible to the patients, or be protected by ornamental open wire work on a line with the corridor; this arrangement gives nearly every advantage of light, air, and scenery. Behind such a screen, even in the most excited wards, may be placed with entire security, the most beautiful evergreen and flowering plants, singing birds, jets of water, and various other objects, the contemplation of which can not fail to have a pleasant and soothing effect upon every class of patients.17
The Kirkbride plan called for twelve-foot ceilings in all the patient wards with sixteen-foot ceilings in the central administrative section. Hospital residential corridors should be at least twelve feet wide, with those of the central building sixteen feet wide. Spacious corridors and high ceilings facilitated good ventilation; indeed, the Athens asylum was situated so as to take advantage of the prevailing breeze through the large and plentiful windows.18 The parlors and other large rooms on each floor of a Kirkbride hospital were each twenty feet square. Patient bedrooms were kept small enough (about a hundred square feet) so that their dimensions would not encourage placement of two patients in the same room:
The single chambers for patients should be made as large as can be well brought about, provided their dimensions are not so great as to lead to two patients being placed in the same room, which ought not to be allowed. Nine feet front by eleven feet deep will probably be adopted as the best size, although eight by ten is admissible, and has the advantage that when not larger than this, two patients are not likely to be put into one room. If the rooms are larger, this is almost certain to be done whenever a hospital becomes crowded, and it is really never either proper or safe, to have two insane patients sleep in the same room without an attendant in it, or in an adjoining one. Great convenience will be found in having in each ward at least one chamber of the size of two single rooms, for the use of a patient with a special attendant, or in cases of severe illness.19
Compassionate, supportive treatment of those with mental illness was a sea change, a manifestation of the great Victorian impulse to provide systematic, decent public care for vulnerable individuals—those with mental illness, orphans, the poor, and persons in need of medical care.20 The nineteenth century in America ushered in a national outpouring of support for social institutions: medical hospitals, mental hospitals, universities, public schools, penitentiaries, YMCA and YWCAs, the Red Cross, orphanages, settlement houses, schools for blind persons, and schools for deaf persons. This groundswell of support rose in response to the needs of family, community, and industry. With postwar industrialization, the decline of an agrarian economy, and the rise of cities, asylums and other institutions were expected to serve a humanitarian function and also to provide a measure of social stability. By today’s standards, this charity movement led by social reformers, many of them women, was paternalistic, selective, and moralistic. Many of the major community institutions in America today were invented in the nineteenth century to bring order to or meet social needs created by industrialization and urbanization of American life.21 Orphanages, libraries, public schools, colleges and universities, health clinics, penitentiaries, parks, hospitals, and asylums for those with mental illness were among the institutions developed by states working with networks of community organizations and social reformers to alleviate poor living conditions in nineteenth-century American towns and cities.
Discussion among asylum scholars, former asylum patients, historians, and sociologists about the