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

Carla Yanni begins her book with the statement that “Nineteenth-century psychiatrists considered the architecture of their hospitals, especially the planning, to be one of the most powerful tools for the treatment of the insane” (1). Nowadays, historians of medicine study cures and treatment; historians of architecture study environments. No wonder that no work focusing on asylum design has appeared since Henry Burdett’s gargantuan works of the 1890s; at least, that is, until now.

In The Architecture of Madness, Yanni, an architectural historian, investigates American asylums and their designs from the late eighteenth century to the end of the nineteenth century. She considers the history of buildings alongside the history of treatment and the history of asylum superintendents alongside the history of architects and landscape designers. With an expressed interest in how the buildings were received as well as intended, Yanni also investigates, as much as possible, the varying spatial experiences and freedoms (or restrictions) of the inhabitants, inmates as well as administrators. If asylum architecture was integrally linked to the career trajectories of nineteenth-century asylum-keepers and superintendents, it also encompassed the limit of environmental experience of its numerous and often long-term inmates. While Yanni hopes to make a contribution to the history of psychiatry as well as architecture (7), psychiatric history buffs and practitioners should note that she does so by applying the existing historic research and analysis to the building histories and she does not examine Freudian psychology as an influence on building design. In fact, she makes the case that “Freudian psychoanalysis had almost no effect on the architecture of American psychiatric hospitals” (147).

Yanni divides her book into four chapters; Chapters 2 through 4 cover relatively untrodden historical ground. Chapter 1, “Transforming the Treatment,” examines how the building design of asylums became linked to the cure of inmates by discussing first the negative models of the palatial but largely custodial (and inhumane) European institutions and then the establishment of more positive curative institutions. She then discusses the shape of early institutions in America. Chapter 2, “Establishing the Type,” examines the establishment of the distinctively American Kirkbride Plan hospital (named after its creator, Thomas Story Kirkbride) and reveals the critical role of asylum superintendents in making that plan the standard throughout the country. Chapter 3, “Breaking Down,” reveals the architectural countercurrents against these large Kirkbride plans, by chronicling arguments for and examples of smaller-scale institutions and buildings, such as those promoted by the Cottage Hospital movement. Chapter 4, “Building Up,” ends with a look at several case studies of post-bellum hospitals, both Kirkbride and Cottage planned. Yanni also briefly tackles the late-nineteenth and twentieth-century development of neurologists who saw insanity as the result of bodily lesions or imbalances, and the more recent larger scale turn against institutions, and against institutionalization itself as a treatment.

While roughly chronological, the book presents ideas and buildings largely through independent case studies of asylums selected for their significance in demonstrating “changes in the development of the building type” (12). The case studies are well chosen and well varied, including, among others, the Friends’ Hospital, South Carolina Insane Asylum, St. Elizabeth’s, the Willard Asylum, the Illinois Eastern State Hospital for the Insane at Kankakee, and the Buffalo State Hospital for the Insane. The case study approach, however, makes for a book that is a sequence of separate short stories about buildings rather than one overarching narrative. This is a strength (it keeps the incredible complexity of a long historical period intact) and a weakness (it leaves the inter-relation between the various thoughts, buildings, and people at times incompletely realized). Yanni also physically limits her examination of each institution to its site boundary— the asylums are consequently seen in relation to each other, not necessarily to their individual surroundings or neighboring cities.

Despite the inherent dangers of an interdisciplinary topic with so many intersecting specialties...