The Historic
Dimension Series
A student publication series by the UNCG Department of Interior Architecture
The Kirkbride Plan:
A Doctor’s Interpretation of Moral Treatment
and its Reflection on Architecture
by Mardita Murphy Spring 2015
The American
Enlightenment and the
subsequent American
Revolution radically altered societal values
due to several factors including responses
to the disarray of the nineteenth century
city and industrialization. The approach of
therapy, known as moral treatment,
revolutionized psychiatric treatment
methods during the late 19th century. Moral
treatment was conceived by European doc-tors
and then interpreted by American psy-chiatrist
Dr. Thomas S. Kirkbride, who was
responsible for a novel building type design
that significantly affected the American
landscape. This moment of change gener-ated
a substantial influence on American
architecture and landscapes by way of the
Kirkbride building type. This brief explores
the philosophy of the Kirkbride building
plan as a treatment strategy and its impact
on our built environment.
Record of Psychiatric Treatment
Prior to the era of moral therapy and the
rippling ramifications the ideology played
on society, the psychiatric discipline, and
architecture, the idea and treatment of mad-ness
was an extremely inhumane and mis-understood
practice. Historians like Scull
(1981) point out that prior to moral treat-ment,
if a mentally-ill person threatened the
community, they would be restrained in
shackles in damp, dungeon-like spaces;
otherwise, an acquiescent lunatic was
allowed to roam villages freely. The
community might mock or make fun of
said persons, but would commonly assist if
needed. Although asylums and the
practices within them were not always
perfect, they were a noteworthy
improvement for the dependent
communities over wet cellars or cage
housing.
Moral Therapy
Responding to European thinking and
practices in the past, psychiatrists in the
developing field began to address the
mentally ill community with new
perspectives. As America matured into the
Enlightenment movement, a common sense
of civic and religious responsibilities
resulted in humanitarian reform during the
course of the eighteenth century.
Reformers hoped to modify all of society’s
institutions, such as schools and colleges,
prisons, insane asylums, and medical
hospitals, precipitating new structures to
support the revised institutions to convey
the rationale of American society (Yanni,
2007). Part of that movement involved the
emergence of a novel and prevalent
American form supported by the theory
of moral treatment. In his book, The Mad
Among Us, Grob (1994) credits two individu-als
with the transition in thinking about
the mentally ill—doctors William Tuke and
Philippe Pinel—because they both chose to
release said individuals from chained re-straints
in dungeon-like settings. They were
working separately, yet both considered the
idea of moral management as pertaining to a
philanthropic caretaking method gently
guiding an individual to stability. Further,
Pinel, Tuke, and other progressives’ work
“It is in that
golden stain
of time that
we are to
look for the
real light,
and color,
and pre-ciousness
of
architecture.”
-John Ruskin
UNCG The Historic Dimension Series: 2
Fig. 3: Patients tending to gardening and farming tasks
on site, pictured here in a greenhouse.
led to a consensus that insanity was not a chronic condi-tion
but rather a curable phenomenon requiring sensi-tive
care and a proper retreat-like environment.
Psychiatric history shows an evolution of the thinking of
madness, which directly reflects the thinking of sanity
or normalcy, according to Rothman (1971). Rooted in
English tradition, the thinking illustrates a continuous
procession towards humane and rational forms of
treatment. Scull (1981) reports the foundational cor-nerstone
of the approach being to contain a madman,
introduce “external discipline and constraint” and break
down the will of the individual. The treatment sought to
transform the individual, remodeling behavior towards
the contemporary ideal of a rational being. Moral
management was to restore the ill person to reason
by way of a system of rewards and negative reinforce-ment
to instill civility similar to how one educates youth
to a moral code.
Moral Architecture: The Kirkbride Plan
Superintendent of the Utica State Hospital and editor of
the American Journal of Insanity, Dr. John P. Gray was a
prominent character in the field of institutionalized care
of the insane. Standing on the shoulders of the moral
influences of Pinel, Tuke, and Gray, Dr. Thomas S.
Kirkbride generated a collection of principles to guide
the organization of the asylum. Kirkbride’s
interpretation of moral management was implemented
through the hospital he managed, Pennsylvania Hospital
for the Insane, considered the masterpiece of American
psychiatry of the nineteenth century. The Kirkbride
system was the earliest scientific reaction to the
challenge of treating insanity as a disease. Prior to this
acknowledgement, insane persons were commonly
housed in rural almshouses and prisons. Kirkbride
agreed with his physician predecessors, concluding that
insanity was curable and capable of reason, restraints
were unnecessary, and finally that a specific
environment would support the individual’s
rehabilitation (Ziff, 2012).
Society and the field of psychiatry placed a great deal
of stock in the belief that a curative environment would
foster a cured and civilized person. The Kirkbride
building type generated from this theory produced
physical evidence of nineteenth century psychiatric
doctrines. In 1854, Kirkbride published his treatise on
the construction, organization, and general arrange-ments
of hospitals for the insane, and the Association of
Medical Superintendents of American Institutions for
the Insane (AMSAII) adopted the intrinsic guidelines.
According to Ziff (2012), the era of the asylum is framed
by 1848 to 1890 when the largest concentration of Kirk-bride
hospital construction materialized on the Ameri-can
landscape. During the nineteenth century and early
segments of the twentieth century, asylum presence
grew rapidly. According to Dr. Henry M. Hurd’s
assessment in 1917, there were 297 institutions for the
insane in the United States, including both public and
private facilities. Of accounted sites, close to 80 were
built to the Kirkbride plan specifications (Ziff, 2012).
Fig. 2: An illustration of madness in Charles Bell,
Anatomy and Philosphy of Expression as Connected
with the Fine Arts
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Fig. 4: Led by Thomas Kirkbride, Pennsylvania Hospital
for the Insane opened this facility based on the Kirkbride
plan in 1841.
Fig. 5: Buffalo State Hospital Central Administration
Building, Buffalo, New York
The Kirkbride plan carried many specifications and
features that Dr. Kirkbride obviously considered in great
detail. He began with site details suggesting that
hospitals should be located in a country setting, on the
periphery of cities and towns. Further, he recommended
this site be apportioned with at least fifty acres for
gardens and fifty acres for farming and other uses. Land
quality was of utmost importance to Kirkbride; he
specified that the land be easily tilled, the scenery be
diverse and inviting, and for the adjacent neighborhood
objects to be similar in character. Buildings should also
be positioned on site to take advantage of prevailing
winds through large, numerous windows.
According to Thompson & Goldin (1975), Kirkbride
prescribed that all buildings be three stories and house
250 patient beds with wards to organize patients by sex,
severity of illness, and class. The building plan included
a central administration building operating as the grand
entrance. The administration building held offices for
superintendents or directors, doctors, and staff as well as
living quarters on the upper floor. This building typical-ly
held the complex chapel so male and female patients
were unable to see one another from their separate
wards. An ornamental dome capping the central build-ing
was utilized as a storage space for iron tanks to col-lect
and store water that would later be relayed to each
connecting ward. The dome space was also intended as
an observation deck offering a panoramic view of the
complex and surrounding landscape. For this building,
Dr. Kirkbride outlined the corridor widths to be sixteen
feet wide with ceilings also reaching sixteen feet high.
The facade incorporated repetitive bands of windows
along with a portico positioned in front of the director’s
office and parlors for family use. The rear of the central
building also had porches on looking the courtyard and
complex center.
Kirkbride proposed the wings be offset to the rear
allowing corridors to be open to the sun and wind on
both sides. Ward interiors consisted of corridors of
sensible length with bay windows in the middle so the
double loaded corridor method would not inhibit light
and ventilation. This detail was required to allow day-light
and natural air into the darkest space in the ward
allowing fresh air to circulate throughout the pavilions
as if they were freestanding separate structures. A ten
foot space was incorporated at each joint of the wings
and the central structure with windows that could be
opened from floor to ceiling on both exterior walls on
all stories. According to Dr. Kirkbride, pavilion corri-dors
should reach twelve feet in length with moveable
glazed sash extending from floor to ceiling which could
either be accessible to patients or secured by ornamental
wire grilles. Ceilings in pavilions should be twelve feet
as well; high ceilings and spacious corridors increased
building ventilation capabilities. Since buildings were
connected and because these were medical facilities, fire-proofing
was extremely important. Kirkbride required
fireproof building materials such as stone and brick as
well as fireproofing from cellar to roof with fireproof
doors making the attached wards as safe as individual
structures.
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Parlors and dining rooms were employed centrally in
each ward level to break up the regularity of corridors.
These spaces and other large rooms on each floor were
twenty feet square. Patient rooms were left small to
discourage placing more than one patient in each room
in the case of future overcrowding. Kirkbride specified
patient rooms at least 100 feet square, but an eight by ten
space would be acceptable if necessary. Elegant
carpeting covered the floors, especially in the wide
corridors for acoustic buffers. Interior stairs were
constructed entirely of iron and were built six feet in
width. Most windows were sturdily constructed in cast
iron with windowpanes of six inches by fifteen inches.
Window material and construction specifications
allowed the absence of bars or extra sashes. Details such
as this suggested an image that the asylum was
important for all users.
Interiors were well furnished and spacious. Dr.
Kirkbride suggested atriums on each floor presenting
beautiful evergreens and flowering plants, singing birds,
jets of water, and various other objects.
The building characteristics created a healing
environment consistent with moral therapy theory.
Doctors of the time believed daily schedules would
make patients internalize self-control and the interior
spaces reflected this level of control. Despite the
inherent architectural control, patients were not to be
restrained but respected. Aside from the architecture,
moral treatment also meant a regimented life, eating
healthy foods, plenty of exercise, visitation with the
superintendent daily, and the separation from the merci-less
city. Yanni (2007) explains that patients were en-couraged
to perform occupational tasks such as farming,
carpentry, and laundry. With attendance supervision,
patients were allowed to stroll the landscaped grounds.
Impact on the American Landscape
Across American landscapes, grand institutional
complexes for dependent populations endure, reflecting
a moment in the life of our 19th - 20th century culture.
The remaining relics stand as physical evidence of
America’s concept of madness at the time. Further, the
tangible products tied to the perception of insanity also
directly represent our society’s attempt at treatment. A
novel building type emerged to serve as a “use/form”
solution to what was perceived as a social dilemma. The
responsibility of caring for members of this community
shifted from private families to the state governments
driving the sense of a social problem. Hence, the
appearance of a specific, unique building type created
through the interrelationship between the social
institution and the relic, which was required to support
the institution (Schneekloth et al., 1992). This particular
building type was created to solve a social dilemma
during a certain period of time. The results of that effort
exist in the buildings and landscapes due to their
necessity for the goals of the institutions. The evidence
remaining on American landscapes stands as a refer-ence
of who we were as a society and how we addressed
certain issues.
Reuse Challenges
The challenge today is multi-fold. Reduced resident
in-patient population along with shrinking state budgets
leave these complexes neglected, slowly abandoned, or
demolished entirely. These assets are often considered
by states, the property owners, as the ultimate white
elephant where the cost of maintenance far exceeds the
value in the building for the owner. Another obstacle
for preserving these buildings is the social stigma sur-rounding
the complexes due to perceptions of death or
inhumane past events occurring on the sites. Buildings
or sites that are typically included in this group are
prisons, slave houses, battlefields, and insane asylums,
along with other places housing exploitation of a group.
The images surrounding these buildings are negative
due to events when humans acted inhumanely towards
oppressed communities. The issue is that some of these
Fig. 7: Door and Window Drawings from Kirkbride
Fig. 6: Vertical Ventilation Diagram, Kirkbride
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negative memories have greater strength in current soci-ety
despite other positive events or times that may have
occurred there as well. Lastly, a reason why these white
elephants are not managed properly is because there has
yet to be a national regulation overseeing state decisions
in preservation matters such as these. The matters in
question that provoke simple answers. The difficult po-sition
states currently hold requires they determine what
to do with the enormous hospital complexes, which are
too large and too expensive to maintain and apparently
too challenging to retrofit for a new use(s).
The two greatest motives to drive an effort to solve the
difficult situations rest in the loss of an iconic building
type, its inherent history and culture as well as extensive
amounts of capital, materials, and embodied energy.
Several excellent examples of the Kirkbride plan are
shown in figures on the following page. There are a
handful of successful adaptive reuse projects in sani-tariums
throughout the United States. Each is a unique
solution based on individual building characteristics and
local communities needs and markets.
Significance
The authoring team of Changing Places: ReMaking
Institutional Buildings states, “we are confronted with
what is probably the single most important and
valuable reservoir of publicly owned buildings and land
in this country.” They also report that from an analysis
of scholars’ work nationwide on this topic, a theme
materializes indicating economic and political factors
in each state dictate the outcome for these historically
significant institutional buildings and sites. Finally, the
federal government has not established policy to guide
and monitor states’ decisions pertaining to complex
preservation, reuse, or demolition.
The majority of Kirkbride plans were built from 1840-
1883 in the United States. These complexes hold
significance because of the social-humanitarian history
of each state and collectively the country. The movement
was led by a pioneer partnership of psychiatrists and
architects responding to a revolutionary treatment
theory known as moral treatment. The Kirkbride plan
leaves traces of a theory that architecture could cure
madness, if executed properly. Dr. Kirkbride’s system of
hospital design were executed widespread nationwide.
The hospitals incorporated innovative building technol-ogy
like gas lighting, central heating, and large-scale
ventilation systems. Extracted from Broughton Hospital
and Dorothea Dix Hospital National Register Nomina-tions,
these sites cradling the immense complexes are
noteworthy for their advanced progressive treatment
techniques through exposure to nature. Corresponding-ly,
because the buildings and grounds were extremely
sophisticated, they demanded nationally known archi-tects
and landscape architects like Samuel Sloan, Fred-erick
Law Olmstead, and Calvert Vaux. Architecturally,
the majority of buildings are high style with elaborate
attention to ornamentation. The tremendous campuses
were self-sustaining with occupational therapy and ac-tivities
like farming and laundry available to patients.
States such as Ohio and Massachusetts built up to five
asylums for their state over time. Most states had a least
one asylum in one of the many plans developed to
Fig. 9: Greystone Park Psychiatric Hospital in
Morristown, New Jersey
Fig. 8: Columbus Hospital Central Administration
Entrance Interior
UNCG The Historic Dimension Series: 6
support psychiatric treatment. Today, many stand va-cant
awaiting a new use if not already demolished. For
example, the state of North Carolina currently owns two
nearly vacant asylums, one of which is a Kirkbride plan.
Although funding has been allocated by the State now
to study Broughton Hospital for new uses, no concrete
plans exist to initiate planning, programming, and
development. This brief builds the foundation for future
research that will bring light to the inherent issues with
preserving historically significant institutional buildings,
specifically in the case of the Kirkbride Plan hospital.
Conclusion
Practices in psychiatric care have drastically shifted
throughout history. A revolutionary step in this
evolution was moral treatment, which involved a
humanitarian approach to psychiatric treatment. Thanks
to Dr. Thomas Kirkbride, a physical representation of
moral architecture exists in the Kirkbride building plan.
The plan involved connection to nature, occupational
therapy programs, intimate access to doctor and staff
time, and state of the art building technology. As treat-ment
theories shift, so do the building plans to support
those practices, resulting in the Kirkbride’s neglect and
abandonment nationwide. The result being several
grand, underutilized, and vacant complexes. These
white elephants create substantial challenges for prop-erty
owners, primarily states. The significance of these
buildings are driving the need to reassess how we man-age
our cultural resources.
Bibliography
Compagna, B. A. (1986). Adaptive reuse study of the Buffalo
State Hospital, designed by Henry Hobson Richardson. Avail-able
from http://worldcat.org/zwcorg/ database.
Grob, G. N. (1972). Mental institutions in America: Social
policy to 1875. New York: Free Press.
Grob, G. N. (1994). The mad among us: A history of the care
of America’s mentally ill. New York; Toronto; New York:
Free Press, Maxwell Macmillan Canada, Maxwell Mac-millan
International.
Hecker, A. O. (1970). The demise of large state hospitals:
Traditional facilities will be replaced by new kinds of
treatment units. Hospital & community psychiatry, 21(8),
261-263.
Johnson, H. (2001). Angels in the architecture: A photo-graphic
elegy to an American asylum. Detroit: Wayne State
University Press.
Kirkbride, T. S. (1854). Remarks on the construction, or-ganization
and general arrangements of hospitals for the
insane. American Journal of Psychiatry, 11(2), 122-163.
Kirkbride, T. S. (1880). On the Construction, Organization,
and General Arrangements of Hospitals for the Insane: With
Some Remarks on Insanity and Its Treatment. JB Lippincott.
North Carolina. (1937). A study of mental health in North
Carolina: Report to the North Carolina legislature of the gov-ernor’s
commission, appointed to study the care of the insane
and mental defectives. Ann Arbor: Edwards Brothers.
Prior, L. (1988). The architecture of the hospital: A study
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journal of sociology, 39(1), 86-113.
Rothman, D. J. (1971). The discovery of the asylum: So-cial
order and disorder in the new republic. Boston: Little,
Brown.
Fig. 11: Avery Building, Broughton Hospital, Morganton,
North Carolina
Fig. 10: Fergus Falls State Hospital, Fergus Falls,
Minnesota
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Schneekloth, L. H., Feuerstein, M. F., & Campagna, B. A.
(1992). Changing places: Remaking institutional buildings.
Fredonia, N.Y.: White Pine Press.
Scull, A. (1981). Madhouses, mad-doctors, and madmen: The
social history of psychiatry in the Victorian era. Philadel-phia,
PA: University of Pennsylvania Press.
Stewart, A., Lafave, H. G., Grunberg, F., & Herjanic, M.
(1968). “Problems in phasing out a large public psychi-atric
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Talbott, J. A. (1980). State mental hospitals: Problems and
potentials. New York: Human Sciences Press.
Thompson, J. D., & Goldin, G. (1975). The hospital: A so-cial
and architectural history. New Haven: Yale University
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Tomes, N. (1984). A generous confidence: Thomas Story
Kirkbride and the art of asylum-keeping, 1840-1883. Cam-bridge,
New York: Cambridge University Press.
United States. (1938). Patients in mental institutions. Bu-reau
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Yanni, C. (2007). The architecture of madness: Insane asy-lums
in the United States. University of Minnesota Press.
Ziff, K. K. (2012). Asylum on the hill: History of a healing
landscape. Athens: Ohio University Press.
The Historic Dimension Series is a collection of briefs prepared
by UNCG students under the direction of Professor Jo Ramsay
Leimenstoll. For information on other topics in the series please
visit the website at go.uncg.edu/hds
Fig. 11: Danvers State Hospital, Danvers, Massachusetts
Fig. 12: Greystone Park State Hospital, Morristown, New
Jersey
Community Collections
