A Review of
The Architecture of Madness: Insane Asylums in the United States by Carla Yanni

Minneapolis, London: University of Minnesota Press, 2007

Reviewed by Claire Greslé-Favier| Originally published in the Vol. 4 no. 2 (Spring/Summer 2009) issue.

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The American psyche is filled with images of monumental Victorian insane asylums, most of them rather terrifying, such as those in One Flew Over the Cuckoo's Nest, the Batman series or Terry Gilliam’s the 12 Monkeys. Although today, these buildings summon images of fear and mistreatment, their unique and costly architecture was especially devised in the nineteenth century to play a crucial role in the patients’ treatment and well-being.  

In her book, The Architecture of Madness, Carla Yanni, provides an enlightening description of the architectural project and ideology of nineteenth century alienists.Yanni’s book follows the evolution of the architecture of insane asylums throughout the nineteenth century, highlighting first the success of certain architectural types, next, demonstrating how particular designs fell out of favor and finally, the complete fall from grace of monumental hospitals.

Chapter one begins with a discussion of the early attempts at establishing a system to house and cure the mentally ill and the emergence of what would become one of the central concepts of nineteenth century therapy: “moral management” or “moral treatment.” This approach aimed at influencing the patient by providing him/her with a peaceful and soothing environment as well as activities that would serve as a diversion, specifically outdoor activities such as taking walks or boating. This chapter ends by introducing Dr. Thomas Kirkbride, whose vision of the architecture for mental hospitals would become a major influence throughout the nineteenth century. With Kirkbride, alienists would start playing a central part in the conception of asylum buildings, leading in the late 1800s to growing criticisms, the core of which being that mental doctors were more preoccupied with architecture than medical research.

In chapter two, Yanni illustrates the rise of the “Kirkbride,” or “linear plan,” a type of building planned by Kirkbride to provide the best conditions to cure mental patients. For Kirkbride, and for nineteenth century alienists, environment played a crucial part in a patient’s treatment, a belief that reflected the influence of the concept of “environmental determinism,” in Jacksonian America. The Kirkbride plan was centered on a main building housing the chapel, administrative offices, parlors for visitors and the living quarters of the superintendant and his family. The building was divided into two opposing aisles, with men on one side and women on the other. In some hospitals, special quarters were built to house “colored” patients. While the calmest patients were housed close to the center of the building, the most dangerous patients were isolated on the end of each aisle. Depending on the hospital, the wards featured single rooms or dormitories, and common spaces devoted to work or play (billiard room or parlors), as well as large halls or corridors used for exercise in bad weather. The ventilation and heating systems too were important concerns for nineteenth century doctors. The grounds of the hospital were also planned with the utmost care, with landscape architects like Frederick Law Olmsted employed for their conception. They were designed to be beautiful and soothing to the patient, as well as provide a space for wholesome outdoor activities.

In Chapter three, Yanni explores alternatives to the linear plan, such as cottages organized in a village structure. Yet, what Yanni uncovers is that aside from the architectural differences the treatment remained the same, as doctors employed a mix of medical treatment and moral management. By the end of the nineteenth century, monumental mental institutions built along the linear plan were being increasingly criticized as having failed to fulfill their function. Most of these buildings were by then overcrowded and this increase in population completely defeated the intentions of Kirkbride. Indeed overcrowded asylums no longer offered the appropriate environment to influence the patient positively; on the contrary they prevented individual care and the practice of diverting activities.

The Architecture of Madness ends in chapter four with a discussion of the evolutions in architecture design that resulted from the increasing demand for insane asylums, which became both larger and more numerous in the second half of the nineteenth century. Yanni also describes the fall from grace of the linear plan and more generally of mental institutions. By the beginning of the twentieth century, monumental asylums were considered as utter failures, however, as Yanni suggests, it is hard to evaluate if the failure of the Kirkbride plan lay in an inherent inadequacy to the needs of the insane, or to the fact that overcrowding almost always prevented its complete application.

The book also outlines a number of debates, such as the question of whether to separate incurable patients from other patients, which for Kirkbride could only lead to a worsening of these patients condition; the growing notion that most cases were not curable contrary to the early statements of alienists; the competition for respectability between alienists and other doctors, with the figure of the alienist falling from grace by the end of the nineteenth century to the benefit of the neurologist. Importantly, Yanni includes several rare testimonies of patients, which provide a fascinating alternative to the views of doctors and architects. The book closes on a critical reflection on the use of these buildings today, and the difficulty to recycle their specifically planned structure.

Abundantly illustrated with valuable archives, the book manages to summon a very clear image of the different types of asylums it describes and richly conveys the intentions of the doctors and architects who conceived them, as well as what led to the downfall of these buildings.

While its excellent style and fascinating topic make this book an excellent read, it has a slight tendency to catalogue more than analyze and its structure could sometimes be clearer. However, these minor faults do not prevent this work from being an extremely enlightening contribution to the study of insane asylums. The Architecture of Madness brings to light the unique preoccupation of nineteenth century American alienists with architecture and the way these elevated the role of buildings and landscapes to that of ultimate cure against the corrupting and alienating influence of the industrial city.