The Kirkbride Plan

Delaney Hall:
This is 99% Invisible. I’m Delaney Hall, filling in for Roman Mars.

Delaney Hall:
Maybe you’ve heard a story like this, how once upon a time on the outskirts of the town where someone grew up or where they went to school, on the edge of the woods there was a scary old asylum.

Sandy Allen:
Over the last few years, so many people have told me versions of this story.

Delaney Hall:
That’s writer Sandy Allen. They wrote a book called ‘A Kind of Mirraculas Paradise’ about mental healthcare in America.

Sandy Allen:
And often when somebody learns that I write about mental health, they will launch into their old asylum story, how they used to break into one with their friends or how someone they knew saw ghosts there. The details vary.

Delaney Hall:
But the one detail that almost never varies, the thing that seems to make an asylum story an asylum story, is that the asylum is nearly always abandoned.

Sandy Allen:
The former Buffalo State Asylum for the Insane is an imposing stone structure on the north side of Buffalo, New York. It’s nearly 150 years old, and its resident historian, Corey Fabian-Barrett, recently took me inside.

Corey Fabian-Barrett:
This is pretty much what happens when you leave a building sit by itself for 40 years.

Sandy Allen:
The interior was everything you would expect from an old abandoned asylum, with boarded-up windows and long derelict corridors.

Corey Fabian-Barrett:
We’ve got all the paint crumbling off the walls. You’ve got the paint crumbling off of the tin ceiling.

Sandy Allen:
Graffiti that says, “Get out now.”

Corey Fabian-Barrett:
Yeah. Some of the Buffalo State College student shenanigans.

Sandy Allen:
All of the doors had been taken off their hinges. Parts of the building were charred black by fire.

Corey Fabian-Barrett:
Yeah, there have been many fires here. This fire actually took place in 1975, right after the patients moved out.

Sandy Allen:
But it didn’t take the whole building?

Corey Fabian-Barrett:
Nope. Nope. Fire department responded in the nick of time. Also, these buildings are built like medieval castles.

Sandy Allen:
And that’s not an exaggeration. Even though the building was falling apart, it was clear that back in the day it hadn’t just been imposing but fancy. The floors had been laid with designer tile imported from England. The exterior was made with Medina Sandstone.

Corey Fabian-Barrett:
Buckingham Palace is faced in Medina Sandstone. The Brooklyn Bridge, Medina Sandstone. They did not skimp at all.

Sandy Allen:
But more than anything else, the main thing that stood out about the asylum at Buffalo State was its size. The building was huge, over a third of a mile long. It boasted its own subway passage so carriages could take people from one side of the building to the other.

Delaney Hall:
Today there are more than a hundred abandoned asylums in the United States, many of them not all that different from Buffalo State. It’s one of the reasons we’re all so familiar with the idea of the big empty asylum in the woods. Few, however, stop to wonder where all these structures came from.

Sandy Allen:
But in fact, the massive building, the impressive grounds, the fine materials, all of this was part of a treatment regimen developed by a singular Philadelphia doctor, a physician who was obsessed with architecture and how it could be harnessed therapeutically to cure those who’d gone insane, Dr. Thomas Story Kirkbride.

Corey Fabian-Barrett:
Dr. Kirkbride was an amazing man.

Delaney Hall:
When Corey Fabian-Barrett speaks about Kirkbride, you cannot help but notice she is a fan.

Corey Fabian-Barrett:
He was one of the first people in America to say there’s something better we could be doing for people with mental illness, that it was something that could potentially be treated and cured, that it wasn’t just a condition where you would lock somebody up in the basement and throw away the key.

Delaney Hall:
Thomas Kirkbride was a Quaker born in the Pennsylvania countryside in 1809. His father was a farmer, but young Kirkbride discovered early on that he wasn’t suited to farming, and he decided to become a doctor. At first, he wanted to be a surgeon. Then he got kind of randomly talked into working instead at a Quaker-run insane asylum outside of Philadelphia.

Sandy Allen:
A quick note about language. Historically, words that may sound offensive now, like “insane” or “lunatic,” would have been commonplace in the late 18th and early 19th century, even used by medical professionals. So for clarity’s sake, we’ll be using the terminology that Kirkbride would have used.

Delaney Hall:
And back then, when someone was deemed insane, it was often thought to be the person’s own fault.

Carla Yanni:
The assumption was they were, you know, forsaken by God or they were possessed by demons or they had done something to deserve to be in such a desperate condition.

Sandy Allen:
Carla Yanni is an architectural historian at Rutgers who wrote a book called ‘The Architecture of Madness’, and she says that what happened to someone who was labeled insane in the early 19th century would have depended mostly on their class. Wealthy families often kept insane relatives at home or paid for them to live in private madhouses. Poorer people fared worse.

Carla Yanni:
Some of them were kind of cast out to walk along roads. A lot of them ended up in county jails. A lot of them ended up in some kind of small privately-run almshouse.

Sandy Allen:
What madhouses did exist were more like prisons, largely focused on confining and often torturing people. In some, such as England’s infamous Bedlam, the public could even pay to come gawk and laugh at those kept inside.

Carla Yanni:
People would go and look at the patients as if they were animals in a zoo.

Delaney Hall:
But at the Quaker asylum outside Philadelphia, called the Friends Asylum, Thomas Kirkbride was exposed to something very different – a newer, gentler philosophy of how to manage the people in their care. It was called moral treatment.

Carla Yanni:
And the starting idea was that the mentally ill person was not responsible for his or her illness.

Delaney Hall:
Pioneered by a small handful of asylums in Europe, moral treatment was part of a growing trend among professional physicians who believed that patients didn’t have to be confined indefinitely. Instead, they could be treated, even cured.

Carla Yanni:
That meant the person should get enough rest, should sleep on a regular schedule, should eat healthy food, should go for walks and get exercise, should go out and experience nature. All of those things were built into treatment.

Sandy Allen:
Kirkbride worked a few years at the Friends Asylum, learning and practicing moral treatment. Then in 1840, he became superintendent of his own asylum, the Pennsylvania Hospital for the Insane, and it was here that he began thinking about another way to treat insanity.

Delaney Hall:
More specifically, he started thinking a lot about the environment where patients were treated.

Carla Yanni:
Because there was a ward for the mentally ill in the basement, patients were kept in very small cells, and I think they were given food, maybe blankets, but not much more than that. And it was in the spirit of reforming that basement ward that Kirkbride tried to think about a new way to treat people.

Sandy Allen:
As part of a push to get patients out of that prison-like basement, the hospital had already commissioned a brighter, more spacious building in the countryside, but Kirkbride came to believe that even this wasn’t enough. Specifically, he wished an asylum superintendent like him, who actually treated insanity, had been consulted when the building had been designed.

Delaney Hall:
So a few years later when he was finally given the opportunity to construct his own facility for the hospital, Kirkbride began to experiment. The architecture of the building, the landscaping of its grounds, the efficiency of its operation, even the demeanor of the staff, nothing was left to chance. And when he was done, he set down everything he learned in an extremely detailed book called…

Sandy Allen:
‘On the Construction, Organization and General Arrangements of Hospitals for the Insane, with Some Remarks on Insanity and Its Treatment’

Carla Yanni:
And it’s a how-to book.

Delaney Hall:
A book on how to construct the perfect asylum.

Carla Yanni:
There’s an illustration of the model asylum. There are pages and pages about how to design the heating system, what to do about running water. There are descriptions of how to design the windows so that they look like ordinary windows…

Sandy Allen:
But also so they would prevent patient suicides.

Delaney Hall:
Most patients of this era were committed by their families and wouldn’t be free to go, but Kirkbride didn’t want people to feel like they were in a jail, so the fence around the asylum was also disguised.

Carla Yanni:
So he recommends building a trench, kind of slowly slopes down. Then you put the wall in the trench and then you build it back up on the other side.

Sandy Allen:
That way it’s still wouldn’t be possible for a patient to escape.

Carla Yanni:
Or the word they used was “elope.” It’s not possible for a patient to elope, but you can’t see a big, looming giant wall from inside the hospital.

Delaney Hall:
But the most striking aspect of Kirkbride’s plan for this asylum/hospital of the future wasn’t the windows or the fences or the plumbing. It was the building’s shape.

Carla Yanni:
A shallow V shape, like a row of birds in flight.

Sandy Allen:
The V consisted of two diverging series of wards or pavilions. New arrivals would arrive at the administrative building in the center of the V. From there, patients would be first segregated by gender, men going to one side, women to the other.

Delaney Hall:
They would then be segregated by condition, according to four distinct levels of need. Corey Fabian-Barrett says that patients requiring the most care would be kept in the pavilions furthest from the center, which meant that as you improved, you’d literally move towards the exit.

Corey Fabian-Barrett:
So the kind of optimistic philosophy there is you’d show up in terrible shape, you need so much help, you’re sent to the fifth building. The magical curative powers of the architecture and the Kirkbride Plan and keeping active would make you a little bit better, and you’d go to four and then three, two, one, and then you’d walk out the front doors.

Sandy Allen:
Since each of the pavilions would be set back slightly from the last, attendants could easily open windows on all four sides, aiding in ventilation. The narrowed points of contact between sections also protected against fire, making it easier to seal off any one part of the facility from the others.

Delaney Hall:
Nature itself was thought to be curative, and so Kirkbride called for the asylum to be surrounded by parkland. That meant as you walked down the building’s tiered corridors with their tall ceilings, in almost every direction you turned, you would see towering landscapes of greenery and sky.

Corey Fabian-Barrett:
The idea was for the asylum to feel like a Victorian home, and each ward was supposed to be structured like an ideal Victorian family unit. So they all do everything together. The doctor has meals with them at the head of the table to model an ideal of Victorian fatherhood. The nurse – the matron – is at the other end of the table as the mother, and they’re all acting like this family.

Delaney Hall:
And if that scene strikes you as a bit paternalistic, that wasn’t unusual for the time. A whole moral reform movement was building around the idea that society had a duty to provide care for the less fortunate, much like a father should provide for his children. One of the most famous reformers was a teacher from Massachusetts named Dorothea Dix.

Sandy Allen:
Dix toured the country counting and writing reports on the condition of what she called the “insane poor”. She wrote powerful speeches she’d then have men deliver on her behalf. As a woman, she was barred from speaking herself to state legislatures. Nonetheless, one by one, she got 20 states to fund public asylums.

Carla Yanni:
And so they were paid for with taxpayers’ dollars, and this was a time when American states didn’t pay for much of anything. They barely paid for roads.

Sandy Allen:
Kirkbride and Dix corresponded frequently, allies in the battle to fund asylums. He even included a section in his book addressed to the same officials Dix would have been lobbying. He reminded them that anyone, including them, could go insane. It didn’t matter their race or creed or class. Kirkbride called insanity “the great leveler”.

Delaney Hall:
So when the elegantly titled ‘On the Construction, Organization and General Arrangement of Hospitals for the Insane, with Some Remarks on Insanity and Its Treatment’ hit the stands…

Corey Fabian-Barrett:
It was wildly popular. It’s super dense. If you read it today, you can’t believe that this was popular, but it is 1854 and people loved it.

Delaney Hall:
Asylums began popping up all across the country. In 1840, the United States had just 18. By 1880, there were 139. Most of them were built with state funds and were designed in accordance with the Kirkbride plan. The plan gave an architect everything they’d need to build a beautiful optimally functional asylum. With their distinctive V-shape, they were soon known simply as Kirkbrides. Which is how the City of Buffalo, New York ended up with that giant Kirkbride that Corey Fabian-Barrett was showing me around earlier.

Corey Fabian-Barrett:
This building was a result of intense competition.

Delaney Hall:
Any self-respecting American town desperately wanted its own Kirkbride. It would be seen as a source of jobs and prestige. So when the New York legislature agreed to fund a new asylum in 1865 to serve the western half of the state…

Corey Fabian-Barrett:
There’s a huge competition throughout the western New York region about where this hospital’s going to go. Batavia, Lockport, Buffalo, a few other smaller towns are all jostling for the bid. Buffalo ends up winning, huzzah, by offering a perpetual supply of free water to the hospital.

Delaney Hall:
The state spared no expense. They hired Frederick Law Olmsted, the co-designer of Central Park, to surround the facility with hundreds of landscaped acres, and one of the great architects of the 19th century, H.H. Richardson, designed the building’s exterior, topping it off with two enormous copper-sided towers, almost like the towers of a cathedral. As for what they were for…

Corey Fabian-Barrett:
That’s one of the top questions I get about those towers, like what was up there? What were they doing in those towers? And nothing. They were purely decorative from day one. And as hard as it is to believe that a state project would spend all that money and effort on two massive decorative towers, that is exactly what they did in the 1870s.

Delaney Hall:
But the exterior grandeur of the Buffalo Asylum was nothing compared to what was going on inside.

Carla Yanni:
Hospitals operated almost as towns. They were cities in microcosm. They had a full complement of everything a small town would need.

Sandy Allen:
Kirkbride believed that patients being occupied was key to their recovery so many asylums contained full working farms staffed in part by patients.

Corey Fabian-Barrett:
Cows, pigs, horses, chickens.

Sandy Allen:
Yeah. Like, was it self sustaining to a certain degree?

Corey Fabian-Barrett:
It was, yeah.

Delaney Hall:
Kirkbrides had bowling alleys, dance halls, and baseball diamonds. One even had a kind of pre-electric roller coaster.

Carla Yanni:
The asylum in Poughkeepsie had a nine-hole golf course.

Sandy Allen:
People could even purchase postcards featuring a lovely drawing of the area’s Kirkbride –

Delaney Hall:
Like, “miss you, darling”, here’s a pastel of a lunatic asylum.

Sandy Allen:
Like, literally yes, asylums had become symbols of civic and social achievement, all resting on the belief in insanity’s possible cure.

Delaney Hall:
But from their inception, there was a gap between society’s ambitions for these buildings and how the buildings actually functioned. For one thing, the very size of many of the state asylums built in the late 19th century ended up working against them.

Sandy Allen:
Kirkbride had been adamant, a superintendent should be able to visit each and every patient, so that an asylum should be 250 patients maximum.

Delaney Hall:
But asylum superintendents were under financial pressure. They wanted to increase the maximum asylum size to 600 to take on more paying patients. So at the superintendent’s annual meeting, they held the vote.

Sandy Allen:
Kirkbride voted against the measure, but it passed anyway.

Delaney Hall:
So when H.H. Richardson designed the Buffalo Hospital for the Insane in the early 1870s, he designed it for the maximum 600.

Carla Yanni:
So there were never enough attendants. There weren’t enough nurses, which ruins all of the aspects of the moral treatment.

Delaney Hall:
But the larger problem was that many patients staying at Kirkbrides didn’t leave. From the beginning, the idea had been that patients in any one Kirkbride hospital would soon be cured, continually making room for new patients.

Corey Fabian-Barrett:
So you’re supposed to come here, be here, take in the Kirkbride-y goodness for no more than a year, and then you’re cured and you go home. This is not how it works in practice at all.

Sandy Allen:
Kirkbride himself claimed that his asylum in Philadelphia had an 80% cure rate. Other superintendents claimed rates as high as 90 or even 100%, but the doctors had been collecting and reporting their own data. So a person who died in an asylum might be counted as cured, while a patient who required a second visit might be counted as two people cured.

Delaney Hall:
The result was that once a Kirkbride asylum opened, it quickly filled up and stayed that way.

Corey Fabian-Barrett:
People are staying here much, much longer, and they realized that within two or three years of the hospital opening. They’re like, “You know what, this doesn’t work as an acute care facility. We’re a longterm care place, and we don’t have enough space to be that.”

Carla Yanni:
So they became places where people who were very poor and very sick ended up living their entire lives – 20, 30, 40 years.

Sandy Allen:
By the mid 20th century, the buildings had become overcrowded, with far more patients than Kirkbride would’ve ever dreamed. Buffalo’s asylum, for example, which, recall, was designed for 600.

Corey Fabian-Barrett:
At the height of this hospital, which was in the 1950s, there were 3,600 patients living here.

Delaney Hall:
The state mental hospitals constructed during the early 20th century grew even larger, and they resembled institutional buildings like prisons. This was the very thing Kirkbride had wanted to avoid. The largest, Pilgrim State Hospital on Long Island, at its apex housed over 14,000 patients.

Sandy Allen:
By 1955, more than half a million Americans were confined in state mental hospitals.

Carla Yanni:
So they became warehouses for humans and they were criticized for causing insanity rather than curing it.

Delaney Hall:
Meanwhile, psychiatrists had turned their focus to curing what were now termed “mental illnesses”. They focused on physical interventions like lobotomies, insulin comas, electroshock treatments, and eventually chemicals marketed as psychiatric drugs.

Sandy Allen:
In the 1960s, new laws prohibited psychiatric patients from working. Without the contribution of patient labor, many hospitals’ infrastructures were brought to a halt. In the 1970s, American state mental hospitals were largely defunded, emptied, and shuttered during what was called deinstitutionalization.

Delaney Hall:
The Kirkbride in Buffalo was finally shut down in 1974, its few remaining patients transferred to a smaller facility next door. By that time, almost everything about the original purpose of these buildings and others like them had been forgotten. Asylums were reduced to the role of a pop culture trope, one built entirely out of their last gruesome chapter.

Batman Clip:
“Welcome to Arkham, Batman.”

Sandy Allen:
Take Batman’s Arkham Asylum, sitting just outside Gotham, alone on a hill, with its grand Gothic architecture.

Batman Clip:
“Don’t bother screaming for help. The white coats can’t hear you.”

Sandy Allen:
Or the terrifying institutional nightmare of ‘One Flew Over the Cuckoo’s Nest’.

Mr. Cheswick:
“May I have my cigarettes please, Miss Ratched?”

Delaney Hall:
Which was incidentally filmed in a Kirkbride in Oregon, featuring many actual patients as extras.

Nurse Ratched:
“I heard your question, Mr. Cheswick, and I will answer your question as soon as you’ve calmed down.”

Delaney Hall:
And then there’s pretty much anything from season two of the FX Ryan Murphy show ‘American Horror Story: Asylum’.

AHS Asylum:
“Please help me. I don’t belong here. Get me out of here.”
“Is electroshock therapy something you would suggest?”

Christopher Payne:
You know, what bothers me is when they try to get you to admit that they’re creepy places.

Sandy Allen:
Christopher Payne is a photographer who’s probably been inside more Kirkbrides than anybody else. He photographed 70 abandoned mental hospitals in 30 states for a book called ‘Asylum: Inside the Closed World of State Mental Hospitals’.

Christopher Payne:
That’s a question that gets asked endlessly, ‘What was it like inside? Was it creepy? Did you see any ghosts”? I didn’t find them creepy, and at the very opposite, I felt lucky to be in them and to be able to photograph them.

Sandy Allen:
Before he was a photographer, Chris Payne was actually an architect, so to him, that these places used architecture itself as treatment was all the more impressive.

Christopher Payne:
I think that when you go to architecture school, every architect dreams that their design or their building is going to sway someone, you know, move someone on that level, change their lifestyle, change their mind.

Sandy Allen:
The power these buildings once had to change peoples’ minds, that was part of what Chris wanted to capture.

Christopher Payne:
Because once something’s been abandoned for 30-40 years, and once you vandalize it and once you strip things out and once things start to fall in on each other, it could be any abandoned building. Could be anything. So it was very hard to find those moments that were still intact and that were very specific to this way of life. And so I spent hours, days inside them taking pictures.

Delaney Hall:
And what Chris found is that, despite decades of disrepair, the buildings were still beautiful. The light still flooded in through the stately windows. The trees planted 130 years ago had grown tall and graceful. But he also found evidence of what had made Kirkbrides self-sustaining, vats for making sauerkraut, a beauty parlor, three dresses handmade by patients.

Sandy Allen:
Seeing his photos helped me imagine a little what life might have been like at these institutions when they were truly operational. They gave me a little glimmer of a group of people whose silence in this historical narrative is always very loud to me, the patients themselves. There’s this one photograph of Chris’s I keep thinking about.

Christopher Payne:
There was a cabinet of toothbrushes at Hudson River State Hospital in Poughkeepsie.

Sandy Allen:
Like, dozens of toothbrushes – orange, red, green, blue, pink – each carefully labeled.

Christopher Payne:
And for some reason, when they emptied out the ward, they left this cabinet, this cupboard of toothbrushes, each with the patient’s name on them.

Sandy Allen:
The image says that’s how many people once called this place home. That’s how many people once hung their toothbrush here. And it says that this is how hastily this space was abandoned. Wherever these folks went next, they didn’t get to bring their toothbrush.

Delaney Hall:
Of the few dozen Kirkbride buildings that are still standing, many are in the process of slowly decaying. They’re regarded as public nuisances or expensive headaches. A handful have managed to stay open, though often in a very diminished capacity, a small portion of the building used for some administrative function while the rest is abandoned.

Sandy Allen:
Some Kirkbrides have been or are being transformed into condos. Another one in Sydney, Australia became home to an art school.

Delaney Hall:
And then there’s the Kirkbride in Washington, D.C., St. Elizabeth’s. It’s about to become the headquarters for Homeland Security.

Sandy Allen:
As for the Kirkbride in Buffalo, it’s not entirely abandoned either. Part of it is now a luxury hotel. Corey Fabian-Barrett told me it’s an especially popular spot to get married, sometimes because the couple is interested in the history of the asylum.

Delaney Hall:
Although other times, she says, they just want a place that looks like Hogwarts.

Sandy Allen:
Strolling the hotel’s long bright hallways, I could sometimes catch a glimpse of the still abandoned part of the asylum, just one wing over. On the building’s front were these somewhat menacing-looking caged-in porches. I’d noticed them when I first arrived, although actually standing in one had been nothing at all like I’d expected.

Corey Fabian-Barrett:
We can go out on the porch, actually.

Sandy Allen:
Oh, this is a porch?

Corey Fabian-Barrett:
Yeah.

Sandy Allen:
Whoa.

Corey Fabian-Barrett:
It’s one of my favorite places. I love it out here.

Sandy Allen:
Yeah, so this is a terrace.

Corey Fabian-Barrett:
Right.

Sandy Allen:
It’s not a cage.

Corey Fabian-Barrett:
Yeah. This is one of my favorite places to bring people on tours because I’m the first one to admit, they look terrible from the outside. They do look like a cage, but once you actually stand in them and get out in them, you get a totally different perspective, and you’re like, “Oh yeah, this would’ve been a nice spot.”

Sandy Allen:
Yeah. This is cool.

Corey Fabian-Barrett:
Yeah.

Sandy Allen:
Wow.