New Tool for Treating Mental Illness, ca. 1817

The NY Times recently reported on “A New Tool in Treating Mental Illness: Building Design.”1 Looking at a couple of mental health facilities in California, one recently completed and one still under construction, the article highlights some of the building and design innovations found at these institutions: private rooms with nice views of the outside, a more residential look and feel, outdoor recreational spaces, windows that are secure while still allowing people to look out and enjoy the decorated landscape, even efforts to lower the harsh and unnecessary noises.

The Taube Pavilion, featured recently in the NY Times, is celebrated for its innovative approach to mental health care.

Patients, we read, respond better when they have exposure to nature, have private rooms, access to communal spaces and the outdoors, and don’t have to endure excessive noises of medical equipment. Apparently, it is something of a revelation that mental health institutions should be secure, “engineered to ensure safety” but should not look too “prinsonlike [sic].”

The Friends’ Asylum, ca. 1830, celebrated for its innovative approach to mental health care.

All of this sounds familiar and, frankly, oh so 19th century.2 In 1812 the local Friends of the Philadelphia Yearly Meeting laid the groundwork for what would become the Friends’ Asylum near Frankford (then in the country north of the city). The entire project — from finding a suitably peaceful and rural location to designing and building the structure to creating wooded pathways for residents to walk and enjoy as well as the understanding of mental illness as shaped by the built environment — was, at that time, radically innovative.3 And the Quakers understood that they were being innovative:

When members of the Quaker community in Philadelphia decided to erect an asylum for “Persons Deprived of the Use of Their Reason,” they emphasized their innovation in the treatment of the insane. They claimed to reject the earlier regime of physical coercion reliant on therapeutics of restraint, corporal punishment, and threats of deprivation that sought to compel patients to act rationally. They replaced that regime with therapeutics of kindness, a “moral treatment.” The asylum-founding Quakers believed that the frenzies and violent behavior of the mad were products of the brutal treatment these unfortunate persons had endured, not justifications for such treatment. The Quakers’ moral treatment of the insane denied organic or physical causes and focused instead on the emotional and rational causes of madness. The Quaker ethos of care emphasized the patients’ humanity and ascribed to them a fundamental role in recovering their reason; an agency that disrupted longstanding ideas of the mad as being without the capacity to act in meaningful ways. Moral treatment was built around non-medical therapeutics that managed all aspects of a mad person’s environment without the appearance of coercion or restraint. The Quakers sought to create means of confinement without the appurtenances of imprisonment. The asylum should be domestic rather than punitive and should embody “not the idea of a prison, but rather that of a large rural farm” while ensuring safety and security for all members of the family. In the Quaker asylum, appearance and affect were fundamental features of treatment.4

Over the next six or seven years the Quakers worried about, debated, and redesigned every aspect of a typical asylum. They formed committees and subcommittees to study the most minute detail. For example, the Subcommittee on the Admission of Light and Air agonized over how to make an iron window sash that didn’t look like iron, one that provided security and aesthetics, so that patients could not only see out and benefit from the restorative powers of nature but could also open and close the window to enjoy the fresh air. In another instance, the Building Committee rejected the use of then standard bolt locks on residents’ doors because “The cheerfulness of Asylums has, in too many instances, been sacrificed to security; every door has been guarded by massy bolts.” So they formed the Committee on Fastenings to investigate and ultimately design a new type of lock that, like the iron sashes, combined security, aesthetics, and therapeutics.5

Beyond the building itself, the Quakers designed paths through the gardens and woods so residents could enjoy the outdoors. Later, they added a circular railway in front of the building for the patients to use.

For more on the founding of the Friends’ Asylum and their efforts to design and build a new type of asylum, see my essay: “The Inmates Window. Iron, Innovation, and the Secure Asylum” (which is not behind a paywall). And while you are there, read some of the other excellent essays in Amy Slaton’s New Materials. Towards a History of Consistency (All of the essays free to read, download, and print. You can also buy a printed copy of the book for the reasonable price of $15.99. Scholarship should not be expensive.)

Amy Slaton’s excellent collection of essays on materials, consistency, and innovation.

Recent efforts to design a new type of institution are, it turns out, remarkably old fashioned. Two centuries ago the Quakers in Philadelphia recognized that the built environment played a fundamental part of therapeutics, and that security, safety, and aesthetics were inseparable in the treatment of mental illness. Design and architecture firms like WRNS Studio, Architecture+ and HGA, as well as hospitals like El Camino Hospital and Montage Health would benefit from having a historian or two on staff to help them recognize when they have designed something new and when they are merely iterating on past innovations. Rather than condemn ourselves to repeating the past, maybe we can learn from it.

  1. Regrettably, because of the economics of journalism these days, the article will likely languish behind the NY Times ’s paywall. But that’s ok, since there’s nothing all that new about building design as a tool in treating mental illness. See, for example, my essay “The Inmates Window. Iron, Innovation, and the Secure Asylum,” in Amy Slaton’s recent volume, New Materials: Towards a History of Consistency. That volume and all the essays in it are free to read and download, as are all of Lever Press’s books. Excellent scholarship, rigorously reviewed, and attractively presented should be affordable. But wait. Ignore this footnote, since the point of this post is to reflect on the longer history of building design as a “tool in treating mental illness.” And stay tuned for a longer reflection on Lever Press and OA scholarship.  ↩

  2. One commenter on the NY Times article noted the role of architecture in the Kirkbride asylums, designed by Thomas Kirkbride. Kirkbride was an active member of the Philadelphia asylum community and strongly influenced by the “moral treatment” approach of the Friends’ Asylum.  ↩

  3. Though even here the Friends’ Asylum was not the first. It was modeled on the York Asylum, built at the end of the 18th century as an asylum for Quakers in York (England).  ↩

  4. This paragraph comes from my essay, “The Inmates Window.” You can also find out more about the Friends’ Asylum at the website Haverford maintains: Quakers and Mental Health.  ↩

  5. This committee also worried about and designed restraint systems for patients’ beds that provided security to the patients and the attendants, but didn’t resemble typical restraint systems. Here, again, they reshaped what iron was in their efforts to realized the therapeutics of the built environment.  ↩