- Freedom and the Cage: Modern Architecture and Psychiatry in Central Europe, 1890–1914 by Leslie Topp
As the United States Congress debates government spending on health care, including funding for mental health services, it becomes increasingly obvious that we have not yet solved the problem of the asylum. Architecture-as-cure, once thought to be a reasonable approach and a beneficial use of government funding, has fallen out of favor, if not always for charitable reasons. How can a historical study of the structures built and used for centuries across the world to house the mentally ill shed light on the question? How can a deep-dive into the architectural features designed to ease the mind and provide care and solace to a vulnerable population help us understand our own responsibilities? These questions form the basis of an international interest in understanding how mental illness has been treated in the past. Where do we go from here?
Leslie Topp's Freedom and the Cage, a coffee-table sized, lavishly illustrated publication, approaches these questions with an emphasis on the architects, planners, and psychiatrists who created some of these environments and an exploration of how those hospitals changed over time. This narrow focus is worthy—her material is often intricate and fascinating and her analysis careful. Unfortunately, it neglects the fundamental problem. Topp asserts in her introduction that her work will focus on the planners as she navigates between formal and contextual analysis. The book does that successfully, in part through dozens of reproduced nineteenth-and early twentieth-century floor plans and photographs from a variety of sources, which both illustrate her points and demonstrate a depth of research in archival materials. However, the book bypasses one of the most crucial elements: the role of the state, which was always the primary client for this architecture. Why did government build and operate asylums? Why did it abandon them? Should it have done so? It also assigns little agency to or role for the patients and staff of these hospitals.
Often, when leading visitors through an exhibition about Washington, D.C.'s, mental health hospital at the National Building Museum, I am asked how America's treatment of the mentally ill compares with that of other countries. St. Elizabeths opened in 1855 as the Government Hospital for the Insane and is still operating, now run by the city. After over a century and a half of construction and planning, the hospital grounds have been home to structures in all the movements Topp discusses—and then some. It is instructive to see the hospital in a wider context of similar European institutions. This book, with its specific focus on the Hapsburg lands in the years around 1900, provides excellent comparison points for the United States and beyond, including (as Topp foregrounds) Central Europe.
Though she leaves aside the American story, we can piece together a remarkably parallel stateside tale. What we know of as the Kirkbride Plan, introduced in the United States by Dr. Thomas Kirkbride and represented by large sprawling structures with wards differentiated by gender, race, and symptom, she refers to as the "corridor style." Though Topp credits the configuration to the colossal castles, chateaux, and other European landmarks, Kirkbride hospitals have different precedents in the United States. In any case, both corridors and Kirkbrides lost favor to (in America) the cottage plan and (in [End Page 95] Central Europe) the villa system. This major architectural shift is important, and forms the basis for analysis in nearly all books and exhibitions about American asylums. For those interested in a European counterpoint, then, Topp's work provides ample evidence that, though apparently developing quite independently, hospitals on both sides of the ocean provided similar physical forms to their patients at similar times.
Topp's particular interest is not comparison, though, but...