Dr. Thomas Story Kirkbride’s method of treatment for mental illness was to provide humane treatment for patients on sprawling hospital grounds which would restore sanity to a damaged mind. He also believed that “the number of patients in any situation should never exceed the number (of patients) whom the superintendent could know intimately.” This method of treatment became known as the Kirkbride Plan and the sprawling, hospitals which were erected to bolster this idea have become known as Kirkbride Buildings.
Most Kirkbride Buildings were built between 1848 and 1890, though there are a small handful of which were built in the early twentieth century. Construction of the buildings closely follows building specifications suggested by Dr. Kirkbride in The Construction of Hospitals for the Insane. Although the architecture of each building is uniquely different, the floor plan and layout of the Kirkbride Buildings remains the same.
The basic layout of a Kirkbride involves a central administration building with two wings which fan outward from the administrative building like two bat wings. Located in the center-most building, along with the administrative services, were the “kitchens, sculleries, main store rooms, a reception room for patients, a general business office, superintendent’s office, medical office and library, visiting rooms for friends of patients, a public parlor and manager’ room, a lecture room or chapel, and apartments for the superintending physician’s family.” The wings of the buildings are segregated by gender, with male patients in one wing and female patients in the other. Wings are divided into as many as eight wards– one ward for each distinct class of patient– with the more excitable patients on the lower floors and furthest from administration. Each wing would also have an additional ward for patients who are ill.
Dr. Kirkbride’s description of an appropriate mental hospital is very detailed. Most of the Kirkbride buildings are the “economical height” of an above-ground basement and two principal stories. Kirkbride even stipulated the height of ceilings in his plan. In every portion of the building occupied by patients, ceilings of twelve feet were required. In the administrative building, ceilings were to be as high as sixteen feet. This was for “proper architectural effect”. Other details which were provided by Dr. Kirkbride include specification of “well-seasoned wood” for the floors of all patients’ rooms, without exception, doors dimensioning six feet eight inches by two feet eight inches, case-hardened locks which added an expense to the building but would “save much trouble afterwards”, keys for each wing were to be “so entirely different, that it will be impossible by any slight alteration to make those for one side open the locks of the other”, and inclusion of a general collection room which would accommodate at least two hundred , or four-fifths of the entire ward population.
Unbelievably, these vast Victorian buildings were only meant to house a maximum of 250 patients, as that was “about as many as the medical superintendent can visit properly every day, or nearly every day”. This was also an effort to make sure that patients were accommodated comfortably and to ensure that overcrowding of the institution would not impact the welfare and recovery of patients– “Every one familiar with institutions for the insane, will recall numerous instances of almost daily occurrence, where a single excitable patient introduced into a comparatively quiet ward, has in an hour almost entirely changed its character.”
The expense to build these Kirkbrides and the upkeep of the buildings cost a considerable amount. Much like the hospitals of today, hospitals from the nineteenth century were required to charge for their services in order to maintain hospitals as well as to keep the ideological small populace of patients. This was something of a hardship in the years following the American Civil War, when many could not pay their long over-due hospital bills.
Correspondence to Dr. Kirkbride from this post-war period indicates the financial instability of the country at this time. In a letter to Dr. Kirkbride dated December 4, 1865, the family of one Savannah patient laments their inability to pay their long-overdue hospital bill:
I received yours of 31st Oct., containing statement of my acct. I have been most anxious to discharge my pecuniary obligation to your Institution, and have omitted no means I could command to accomplish it. I am compelled to confess, however, that from my sadly reduced condition I have found it a severe struggle. The destruction of buildings, steam mill, etc on my plantation, together with the rice & provision crop of 1864, the absence of means to rebuild & resettle the plantation, the impossibility of cultivating it in its present condition, and total abandonment by the Negroes, have left me without income during the present year.
On the ground of my destitute condition, large family of dependent females, and my advanced age, partially incapacitating me for active labour, I take the liberty to ask of your board of managers if they will not relieve me from the payment of the interest charged. I make this appeal because I am unable to pay it without great distress.
The expenditures associated with these buildings did not lead to the ultimate downfall of the Kirkbride system. Rather, the Kirkbride Plan’s loss of prominence in the medical field to other emerging treatments such as psychoanalysis and drug therapy began the decline and ultimate absolution of this system of humane treatment.
Many of the old Kirkbride buildings continued to find use as state hospitals, where they eventually suffered the negative stigmas of overcrowding and ill-treatment of patients through new forms of therapy. Cries of scandal and patient abuse eventually would minimize the use of state hospitals for the treatment of the mentally insane and lead to a lack of financial support for such institutions. Ultimately, this negative stigma would lead to the demise of the Kirkbride buildings.
Many of the old Kirkbride Buildings have since been partially or completely destroyed. Although a few have managed to remain standing, many of these have fallen into disrepair at having suffered years of neglect. It is unlikely that they will be restored to their former glory, though they may still serve as a nod to an archaic form of humane treatment to rehabilitate the mentally insane.
* The Construction of Hospitals for the Insane by Dr. Kirkbride (Selection of Chapters)
* “The Civil War Correspondence of Dr. Thomas S. Kirkbride.” The Pennsylvania Magazine of History and Biography, Vol 83, No. 1 (Jan., 1959), pp. 74-89.