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The Architecture of Madness

Lloyd A. Wells reviews Carla Yanni’s book, The Architecture of Madness. Below is an excerpt from metapsychology:

Yanni is an architect who has written this book about the architecture of hospitals for the mentally ill. It is a topic which was widely treated in the psychiatric literature of the nineteenth century but which is more quiescent now.

She basically discusses four topics in the 160 pages of text, starting with a consideration of the linkage between moral treatment, a major theme in the psychiatry of the late eighteenth and entire nineteenth century, and the architecture required to conduct it. Pinel, the founder of moral treatment, asserted that insanity was treatable and that the mentally ill should be able to walk the beautiful grounds of the Salpetriere. Tuke, in England, had good results with such a model. She then considers the influence of Dr. Thomas Kirkbride, who had very specific ideas about the structure of asylums — ideas which were greatly respected and implemented throughout the United States and to some extent in Europe. Hospitals based on these models had beautiful grounds and a structure of pavilions, connected to each other and arranged in a “V” shape. Kirkbride believed that 90% of the mentally ill were curable. Soon, however, Tuke’s model of 30 patients in an asylum was converted to 600 patients, and then more — often thousands, which placed a strain on both the treatment and the architecture!. Yanni then considers an opposing plan which developed a bit later, the “cottage” plan, in which there were multiple, smaller buildings. Butler and Olmsted were advocates of this approach. Finally she considers various architectural styles of hospitals which developed after the Civil War, ranging from the “hospital architecture” style of Johns Hopkins to styles which appeared like colleges, to a rather motley array of buildings adapted for use as hospitals for the mentally ill. In the era of miasma theory, there was much discussion of cross-ventilation as a desideratum. She concludes with four fascinating appendices on terminology, the occupations of patients in 1850, the construction costs of many of the hospitals, and the sizes of these hospitals between 1770 and 1872.

The author examines the relationship between architecture and treatment in psychiatric hospitals over several centuries.

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