The Architecture of Madness: Insane Asylums in the United States (review)

The Architecture of Madness represents an important contribution to existing scholarship on institutional buildings in nineteenth-century America. Architectural historian Carla Yanni provides a compelling typological study of a single building type—the so-called insane asylum—and shows how architects, builders, and psychiatrists attempted to design facilities that they believed could treat, and in some cases cure, mental illness during this period. She attempts to situate the changing intent behind the design of state-sponsored asylum buildings in relation to shifting psychiatric philosophies on the treatment of the insane. While it neither pretends to be an exhaustive catalogue of nineteenth-century American asylums nor revolves around different users’ daily experience of these spaces, Yanni’s book offers a very useful framework for interpreting asylums throughout the United States.

The Introduction provides background on the author’s interest in this topic and also explains her approach and use of terminology. In her first book, Nature’s Museums: Victorian Science and the Architecture of Display (The Johns Hopkins University Press, 1999), Yanni examined the intersection between buildings and natural history in Victorian Great Britain, detailing how the design of museums responded to new ideas in science and collecting. The approach taken in that book is evident in this new text in that the author grounds her study of mental institutions against the backdrop of science (in particular, the burgeoning profession of psychiatry). As in the earlier project, Yanni looks at a relatively neglected building type, one that falls “into a methodological gap between histories of architectural innovation and vernacular architectural studies” (12). Yanni thus positions herself alongside scholars like Abigail A. Van Slyck who draw attention to buildings that fall outside the gaze of traditional architectural historians and those interested in vernacular architecture. Beyond this, Yanni uses the Introduction to situate her project in the frame of “environmental determinism,” since during the nineteenth century, doctors, architects, and reformers clearly believed that architecture “could not only influence behavior but also cure a disease” (8), including mental illness. Of course, as the author notes, environmental determinism influenced the design of all sorts of nineteenth-century buildings; in her book, this belief provides an organizing frame through which she reads the changing form of these buildings in relation to the history of psychiatric medicine. Yanni also justifies her historical terminology—the use of terms such as insanity, madness, asylum, and lunatic, which would be considered both archaic and offensive in present use—by explaining existing scholarly convention and by offering a detailed appendix on such terms.

Yanni has organized the bulk of her study into four chronological chapters. The first, “Transforming the Treatment,” relates the rise of American asylums in the early nineteenth century to earlier efforts to treat mental illness. Beginning with “notorious Bethlem” in London, well known (often under the name “Bedlam”) for its adverse conditions, Yanni traverses the history of European strategies for housing the insane, efforts to which Americans reacted when developing their own institutions. Key to her story is the rise of Enlightenment ideas of “reform,” which other scholars, including David J. Rothman and Michel Foucault, have persuasively shown led to kinder, gentler treatment of inmates in all sorts of institutions in Europe and the United States. At the end of this chapter, Yanni introduces readers to Dr. Thomas Kirkbride, a pivotal figure in her study, whom she posits as the progenitor of the predominant asylum form in the United States between 1840 and 1880. Yanni discusses Kirkbride in his role as the director of the Pennsylvania Hospital for the Insane, where he first lobbied for reform in treatment of mental illness through building design.

“Establishing the Type” (chapter 2) centers on explicating the distinctive form that American asylums assumed under Kirkbride’s leadership. Beginning with the New Jersey State Lunatic Asylum (Trenton, late 1840s), the first asylum designed under the influence of his ideas, Yanni...