Misplaced Pages

#548451

64-487: The hospital's roots date to 1848 when Wards Island was designated the reception area for immigrants. Some additional structures were originally part of Blackwell's Island Lunatic Asylum, which opened around 1863. The New York City Asylum for the Insane opened in 1863. The building was significantly enlarged in 1871, and a Kirkbride Plan style building was built. After the immigration entry shifted to Ellis Island in 1892,

128-666: A Commissioner in Lunacy for Scotland , and by his election to the Presidency of the Medico-Psychological Association in 1866. Browne's eldest surviving son, James Crichton-Browne (1840–1938), did much to extend his father's work in psychiatry, and, on 29 February 1924, he delivered a remarkable lecture The Story of the Brain , in which he recorded a generous appreciation of the role of the phrenologists in

192-466: 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

256-486: A distinct method by the 20th century, however, due to overcrowding and misuse of asylums and the predominance of biomedical methods. The movement is widely seen as influencing certain areas of psychiatric practice up to the present day. The approach has been praised for freeing sufferers from shackles and barbaric physical treatments, instead considering such things as emotions and social interactions, but has also been criticised for blaming or oppressing individuals according to

320-517: A means of restraint at the Santa Dorotea hospital, building on prior attempts made there since the 1750s. From 1788 at the newly renovated St. Bonifacio Hospital he did the same, and led the development of new rules establishing a more humane regime. The ex-patient Jean-Baptiste Pussin and his wife Margueritte, and the physician Philippe Pinel (1745–1826), are also recognized as the first instigators of more humane conditions in asylums. From

384-476: A mixed meaning of either psychological/emotional (mental) or moral (ethical). Pinel distanced himself from the more religious work that was developed by the Tukes , and in fact considered that excessive religiosity could be harmful. He sometimes took a moral stance himself, however, as to what he considered to be mentally healthy and socially appropriate. English Quaker William Tuke (1732–1822) independently led

448-409: A new form of moral oppression, replacing physical oppression, and his arguments were widely adopted within the antipsychiatry movement . Foucault was interested in ideas of " the other " and how society defines normalcy by defining the abnormal and its relationship to the normal. A patient in the asylum had to go through four moral syntheses: silence, recognition in the mirror, perpetual judgment, and

512-570: A public and a political concern in the US. On a restorative trip to England for a year, she met Samuel Tuke . In 1841 she visited a local prison to teach Sunday school and was shocked at the conditions for the inmates and the treatment of those with mental illnesses. She began to investigate and crusaded on the issue in Massachusetts and all over the country. She supported the moral treatment model of care. She spoke to many state legislatures about

576-407: 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

640-488: 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

704-444: Is a juridical space where one is accused, judged, and condemned." Foucault's reassessment was succeeded by a more balanced view, recognizing that the manipulation and ambiguous "kindness" of Tuke and Pinel may have been preferable to the harsh coercion and physical "treatments" of previous generations, while aware of moral treatment's less benevolent aspects and its potential to deteriorate into repression. The moral treatment movement

SECTION 10

#1732776423549

768-491: Is well documented that there was very little therapeutic activity, and medics were little more than administrators who seldom attended to patients and mainly then for other, somatic, problems. Any hope of moral treatment or a family atmosphere was "obliterated". In 1827 the average number of asylum inmates in Britain was 166; by 1930 it was 1221. The relative proportion of the public officially diagnosed as insane grew. Although

832-665: 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

896-1103: The Oregon State Hospital , and the Eastern Oregon State Hospital , the latter of which now houses the Eastern Oregon Correctional Institution . 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. 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

960-433: The "alleged lunatics" needed re-educating meant it treated them as if they were children incapable of making their own decisions; and that it failed to properly inform people of their rights or involve them in discussion about their treatment. The Society was suspicious of the tranquility of the asylums, suggesting that patients were simply being crushed and then discharged to live a "milk sop" (meek) existence in society. In

1024-447: The "curability" of mental illness were also questioned by the medical community. 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

1088-459: The 20th century the concepts of mental hygiene and mental health developed. From the mid 20th century, however, a process of antipsychiatry and deinstitutionalization occurred in many countries in the West, and asylums in many areas were gradually replaced with more local community mental health services . In the 1960s, Michel Foucault renewed the argument that moral treatment had really been

1152-438: 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. Numerous Kirkbride Plan hospitals and buildings have been featured in

1216-437: 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

1280-646: The Crichton Royal in Dumfries from 1838 to 1859, Browne implemented his general approach of moral management, indicating a clinical sensitivity to the social groupings, shifting symptom patterns, dreams and art-works of the patients in his care. Browne summarised his moral approach to asylum management in his book (actually the transcripts of five public lectures) which he entitled What Asylums Were, Are, and Ought To Be . His achievements with this style of psychiatric practice were rewarded with his appointment as

1344-414: 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

SECTION 20

#1732776423549

1408-578: 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 . 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

1472-693: The Manhattan Psychiatric Center. The current building complex was constructed in 1954. The facility is run and operated by the New York State Office of Mental Health, and the site is surrounded by Wards Island Park, which is administered by the New York City Department of Parks and Recreation . 40°47′21″N 73°55′47″W  /  40.78917°N 73.92972°W  / 40.78917; -73.92972 Kirkbride Plan The Kirkbride Plan

1536-529: The Retreat had been based on a non-medical approach and environment, medically based reformers emulating it spoke of "patients" and "hospitals". Asylum "nurses" and attendants, once valued as a core part of providing good holistic care , were often scapegoated for the failures of the system. Towards the end of the 19th century, somatic theories, pessimism in prognosis , and custodialism had returned. Theories of hereditary degeneracy and eugenics took over, and in

1600-413: The US, and statistics were reported showing high recovery rates. They were later much criticized, particularly for not differentiating between new admissions and re-admissions (i.e. those who hadn't really achieved a sustained recovery). It has been noted, however, that the cure statistics showed a decline from the 1830s onwards, particularly sharply in the second half of the century, which has been linked to

1664-428: The apotheosis of the medical personage. The mad were ignored and verbally isolated. They were made to see madness in others and then in themselves until they felt guilt and remorse. The doctor, despite his lack of medical knowledge about the underlying processes, had all powers of authority and defined insanity. Thus Foucault argues that the "moral" asylum is "not a free realm of observation, diagnosis, and therapeutics; it

1728-532: 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 . 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. The Oregon State Hospital was also featured as

1792-607: 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 . The typical floor plan, with long rambling wings arranged en echelon (staggered, so each connected wing received sunlight and fresh air),

1856-966: The buildings being most commonly preserved. The center complexes of the Hudson River State Hospital 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. Several facilities originally established as Kirkbride Plan hospitals are still active in

1920-538: 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. The majority of the Danvers State Hospital

1984-415: The context of industrialization , public asylums expanded in size and number. Bound up in this was the development of the profession of psychiatry, able to expand with large numbers of inmates collected together. By the end of the 19th century and into the 20th, these large out-of-town asylums had become overcrowded, misused, isolated and run-down. The therapeutic principles had often been neglected along with

Manhattan Psychiatric Center - Misplaced Pages Continue

2048-459: 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

2112-484: The development of a radical new type of institution in northern England , following the death of a fellow Quaker in a local asylum in 1790. In 1796, with the help of fellow Quakers and others, he founded the York Retreat , where eventually about 30 patients lived as part of a small community in a quiet country house and engaged in a combination of rest, talk, and manual work. Rejecting medical theories and techniques,

2176-528: The dream of small, curative asylums giving way to large, centralized, overcrowded asylums. There was also criticism from some ex-patients and their allies. By the mid-19th century in England, the Alleged Lunatics' Friend Society was proclaiming that the new moral treatment was a form of social repression achieved "by mildness and coaxing, and by solitary confinement "; that its implication that

2240-812: The early 1780s, Pussin had been in charge of the mental hospital division of the La Bicêtre , an asylum in Paris for male patients. From the mid-1780s, Pinel was publishing articles on links between emotions, social conditions and insanity. In 1792 (formally recorded in 1793), Pinel became the chief physician at the Bicetre. Pussin showed Pinel how really knowing the patients meant they could be managed with sympathy and kindness as well as authority and control. In 1797, Pussin first freed patients of their chains and banned physical punishment, although straitjackets could be used instead. Patients were allowed to move freely about

2304-968: The early foundations of psychiatric thought and practice. A key figure in the early spread of moral treatment in the United States was Benjamin Rush (1745–1813), an eminent physician at Pennsylvania Hospital . He limited his practice to mental illness and developed innovative, humane approaches to treatment. He required that the hospital hire intelligent and sensitive attendants to work closely with patients, reading and talking to them and taking them on regular walks. He also suggested that it would be therapeutic for doctors to give small gifts to their patients every so often. However, Rush's treatment methods included bloodletting (bleeding), purging, hot and cold baths, mercury, and strapping patients to spinning boards and "tranquilizer" chairs. A Boston schoolteacher, Dorothea Dix (1802–1887), also helped make humane care

2368-482: The efforts of the York Retreat centered around minimizing restraints and cultivating rationality and moral strength. The entire Tuke family became known as founders of moral treatment. They created a family-style ethos and patients performed chores to give them a sense of contribution. There was a daily routine of both work and leisure time. If patients behaved well, they were rewarded; if they behaved poorly, there

2432-616: 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. The first hospital designed under the Kirkbride Plan was the Trenton State Hospital in Trenton, New Jersey by John Notman , constructed in 1848. Throughout

2496-432: The horrible sights she had witnessed at the prisons and called for reform. Dix fought for new laws and greater government funding to improve the treatment of people with mental disorders from 1841 until 1881, and personally helped establish 32 state hospitals that were to offer moral treatment. Many asylums were built according to the so-called Kirkbride Plan . The moral treatment movement was initially opposed by those in

2560-475: The hospital grounds, and eventually dark dungeons were replaced with sunny, well-ventilated rooms. Pussin and Pinel's approach was seen as remarkably successful and they later brought similar reforms to a mental hospital in Paris for female patients, La Salpetrière . Pinel's student and successor, Jean Esquirol (1772–1840), went on to help establish 10 new mental hospitals that operated on the same principles. There

2624-677: The idea that there is a degree of madness in most people because emotions can cause people to incorrectly associate ideas and perceptions, and William Battie suggested a more psychological approach, but conditions generally remained poor. The treatment of King George III also led to increased optimism about the possibility of therapeutic interventions. Under the Enlightened concern of Grand Duke Pietro Leopoldo in Florence, Italian physician Vincenzo Chiarugi instituted humanitarian reforms. Between 1785 and 1788 he managed to outlaw chains as

Manhattan Psychiatric Center - Misplaced Pages Continue

2688-412: 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 100 acres (40 ha) 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

2752-411: 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 (equivalent to $ 50,867 in 2023) if the physician's family resided at the hospital, and $ 2,500 (equivalent to $ 84,778 in 2023) if they found lodging at a private residence. In addition to the medical staff and attendants,

2816-405: The mental health profession. By the mid-19th century, however, many psychologists had adopted the strategy. They became advocates of moral treatment, but argued that since the mentally ill often had separate physical/organic problems, medical approaches were also necessary. Making this argument stick has been described as an important step in the profession's eventual success at securing a monopoly on

2880-600: 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 12 feet (3.7 m) high," but only large enough to room

2944-605: The moral approach may be discerned in Scotland. Interest in mental illness was a feature of the Edinburgh medical school in the eighteenth century, with influential teachers including William Cullen (1710–1790) and Robert Whytt (1714–1766) emphasising the clinical importance of psychiatric disorders. In 1816, the phrenologist Johann Spurzheim (1776–1832) visited Edinburgh and lectured on his craniological and phrenological concepts, arousing considerable hostility, not least from

3008-834: The naturalist Robert Edmond Grant (1793–1874) who exercised a striking influence on the young Charles Darwin during his time as a medical student in Edinburgh in 1826/1827. William Browne advanced his own versions of evolutionary phrenology at influential meetings of the Edinburgh Phrenological Society , the Royal Medical Society and the Plinian Society . Later, as superintendent of Sunnyside Royal Hospital (the Montrose Asylum) from 1834 to 1838, and, more extravagantly, at

3072-465: The nineteenth and twentieth centuries, the campuses of these hospitals often evolved into sprawling, expansive grounds with numerous buildings. 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,

3136-609: 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. 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

3200-417: The patients. Moral management techniques had turned into mindless institutional routines within an authoritarian structure. Consideration of costs quickly overrode ideals. There was compromise over decoration—no longer a homey, family atmosphere but drab and minimalist. There was an emphasis on security, custody, high walls, closed doors, shutting people off from society, and physical restraint was often used. It

3264-707: The primary filming location for the film One Flew Over the Cuckoo's Nest (1975), 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 . † demolished See Yanni, The Architecture of Madness, introduction, for more on environmental determinism. Historical resources Photo and videography Moral Treatment Moral treatment

SECTION 50

#1732776423549

3328-489: 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

3392-903: The standards of a particular social class or religion. Moral treatment developed in the context of the Enlightenment and its focus on social welfare and individual rights. At the start of the 18th century, the "insane" were typically viewed as wild animals who had lost their reason. They were not held morally responsible but were subject to scorn and ridicule by the public, sometimes kept in madhouses in appalling conditions, often in chains and neglected for years or subject to numerous torturous "treatments" including whipping, beating, bloodletting, shocking, starvation, irritant chemicals, and isolation. There were some attempts to argue for more psychological understanding and therapeutic environments. For example, in England John Locke popularized

3456-832: The state took it over from Manhattan in 1899 and expanded it even further, renaming it the Manhattan State Hospital. At the time, it had 4,400 beds and was the largest psychiatric hospital in the world. At the time, it was one of two psychiatric hospitals for residents of Manhattan that had been taken over by the state. The other psychiatric hospital would become the Central Islip Psychiatric Center in Central Islip, New York . Both hospitals were referred to as "Manhattan State Hospital". A fire on February 18, 1923, killed 27 people: 24 patients and three attendants. It later became

3520-411: The theologically doctrinaire Church of Scotland . Some of the medical students, however, notably William A.F. Browne (1805–1885), responded very positively to this materialist conception of the nervous system and, by implication, of mental disorder. George Combe (1788–1858), an Edinburgh solicitor, became an unrivalled exponent of phrenological thinking, and his brother, Andrew Combe (1797–1847), who

3584-437: The treatment of "lunacy". The moral treatment movement had a huge influence on asylum construction and practice. Many countries were introducing legislation requiring local authorities to provide asylums for the local population, and they were increasingly designed and run along moral treatment lines. Additional "non-restraint movements" also developed. There was great belief in the curability of mental disorders, particularly in

3648-438: 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

3712-486: Was an approach to mental disorder based on humane psychosocial care or moral discipline that emerged in the 18th century and came to the fore for much of the 19th century, deriving partly from psychiatry or psychology and partly from religious or moral concerns. The movement is particularly associated with reform and development of the asylum system in Western Europe at that time. It fell into decline as

3776-496: Was an emphasis on the selection and supervision of attendants in order to establish a suitable setting to facilitate psychological work, and particularly on the employment of ex-patients as they were thought most likely to refrain from inhumane treatment while being able to stand up to pleading, menaces, or complaining. Pinel used the term "traitement moral" for the new approach. At that time "moral", in French and internationally, had

3840-470: Was demolished in 2007 in spite of the lawsuit, with only the center portion of the building receiving restoration and conversion into apartments. The Northampton State Hospital in Northampton, Massachusetts , was demolished in 2006. 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

3904-548: Was later appointed a physician to Queen Victoria, wrote a phrenological treatise entitled Observations on Mental Derangement (1831). George and Andrew Combe exerted a rather dictatorial authority over the Edinburgh Phrenological Society , and in the mid-1820s manipulated the de facto expulsion of the Christian phrenologists. This tradition of medical materialism found a ready partner in the Lamarckian biology purveyed by

SECTION 60

#1732776423549

3968-429: 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. The Kirkbride Plan asylums tended to be large, imposing institutional buildings, with

4032-439: 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,

4096-459: Was some minimal use of restraints or instilling of fear. The patients were told that treatment depended on their conduct. In this sense, the patient's moral autonomy was recognized. William Tuke's grandson, Samuel Tuke , published an influential work in the early 19th century on the methods of the retreat; Pinel's Treatise On Insanity had by then been published, and Samuel Tuke translated his term as "moral treatment". A very different background to

#548451