Redevelopment of Abandoned Asylums

The term asylum is defined as an inviolable place of refuge, a welcome haven from pain and suffering. Over the course of the last three hundred years however, the word has gained quite another connotation. "Asylum" is now synonymous with "snake pit", "bedlam", "looney bin". It conjures up images of filthy hallways crammed with half dressed, miserable individuals smoking unfiltered cigarettes while they shuffle mindlessly back and forth in a drug laden, schizophrenic haze.

When America's first hospital for the care of the insane was built in the late 1700's, it was with the idea that treatment would break away from the prison-like atmosphere of hospitals in Europe. Already experiments were being done in the asylums of France to test new theories regarding the ability of mental patients to be treated rather than being permanently confined. Mental health was approaching a revolution, and it climaxed in 1840 when Dr. Thomas Story Kirkbride accepted an offer to become superintendent of the Pennsylvania Hospital for the Insane. Based on his study of the changes being made in European institutions, Kirkbride began work on his own theories which would eventually become the foundation for the era of moral treatment.

The basic tenets of moral treatment appeared sound: treat the mentally ill as you would any other person with a treatable illness. Allow patients a level of comfort and let in the sunshine and fresh air. Encourage them to work on the asylum grounds so that they may contribute to the success of the institution, as well as to the success of their treatment. Kirkbride also believed in using the hospital's architecture to support treatment and his design spawned the building of massive, Gothic inspired castle-like campuses across the nation. The Kirkbride hospitals were beautiful, ornate, and at times, imposing, but patients were treated to rolling hills and pastures, indoor plumbing and central heating, on site theaters and bowling alleys, and other amenities that were previously unheard of in asylums.

However, it wasn't long before the major flaw in Kirkbride's plan was found. Moral treatment relied on a low patient census in order to allow staff to engage with each individual on a more personal level, but in many cases that quickly became impossible. Mere weeks after opening its doors to patients, Worcester State Hospital in Massachusetts was so overcrowded that two more hospitals were built in order to accommodate the influx of patients. State hospitals began to serve not just the mentally ill, but also the poor, the elderly, and the drug and alcohol addicted. Patients with epilepsy and syphilis were being committed by family members who could no longer care for them. Prisoners were sent to the asylums from the overcrowded jails and the homeless were flooding in, looking for shelter and medical care. Kirkbride's vision of a serene, healthy atmosphere was quickly disintegrating.

The hospitals were eventually so overcrowded and the staff so overburdened that the system once again became a warehouse for society's outcasts. The public began hearing tales of back wards where violent patients sat chained to a wall, frothing at the mouth. People walking by the asylums would hear patients screaming to be let out, banging on the bars while they stood naked in their cold cells. They were no longer patients- they were inmates.

Decades continued to roll by and the census in American institutions rose, while the public's view of mental health care plummeted. And as public support for mental health care declined, so did the state budgets, forcing cutbacks across the nation that caused crippling staff shortages and cuts to the already substandard level of care. By the 1960's the push to empty the asylums for good began.

Fueled by even deeper, continued budget cuts, deinstitutionalization took on a life of its own as patients were transferred into community treatment settings at an overwhelming rate. Asylum campus buildings fell into disrepair, eventually becoming completely abandoned. The Gothic Giants were emptied of life and boarded up, left to decay at the top of desolate, weed choked hills overlooking the modern cities that had begun to slowly encroach on hospital grounds.

As the surrounding cities continued to grow, state governments began looking at these abandoned sites as prime development land, since many of the institutions still retained hundreds of acres on their grounds. Most offered picturesque views and relative solitude high above the bustle of the city.

Because of this, many hospitals such as Metropolitan State Hospital, Danvers State Hospital, and Foxboro State Hospital (all in Massachusetts) have been redeveloped into luxury housing. Others, like Northampton State Hospital in Western Massachusetts have been converted into affordable community housing.
However, the push to eradicate these buildings from the American landscape continues. A vast majority of asylums remain boarded and become easy prey for arsonists and metal scrappers. Teenagers dare one another to enter the tunnels and vandals sneak in to spray paint the barren and peeling walls. The buildings stand empty until they begin to bow to decades of abandonment, essentially demolished through neglect.

In spite of some of these hospitals being listed as historical landmarks, most people will say they are glad to see these enormous eyesores disappear. They will relate stories they have heard of patients being abused, sometimes locked away against their will for the term of their natural life. Former staff talk of desolate conditions that made for a bleak environment for every occupant of the building. They say they will be glad to see the horror pass into history.

On the other hand, some recall pleasant memories of a safe haven; one of the few places they ever felt like recovery was possible. Some former staff members say they would willingly return to those wards if given the chance because they felt they were able to truly reach some of the patients, even if it was in the smallest way.

We as American people have allowed the stigma of mental illness and the asylum experience to cloud our decisions to destroy these monuments to one of the most controversial branches of medicine. Many in the medical field still do not recognize psychiatry as an empirically valid practice; some still view it as witchcraft or scientific guesswork that typically yielded disastrous results. Patient advocacy groups continue to push state and federal governments to finance community treatment as opposed to institutionalization, and health insurance companies put rigid restrictions on the use of lengthy hospitalizations for mental health issues.

While this continues, more individuals with mental illness are failing to survive as members of society, many of them becoming homeless or drug addicts. Many more are becoming victims of violent crimes (not the perpetrators as most would assume). Prisons and homeless shelters serve as ad-hoc intake units for those who would once have been committed to a state hospital for treatment. Psych units housed in general hospitals across the United States cannot keep up with the number of cases flooding through their doors and the majority of the individuals who pass through this triage style of treatment aren't there long enough to weather the crisis, especially if they are sent home without a support system to monitor whether or not they take their medication.

It seems we have created a self fulfilling prophecy. The initial human reaction to the conditions in the asylums was outrage, but we satisfied our horror by convincing the government not to pay to treat "those people". After all, why should taxpayers continue to subsidize care for those who are obviously incurable? Unfortunately, the less money the hospitals received, the worse conditions became, prompting not an increase in funding, but yet more cuts until the state hospital system became so debilitated it could no longer function.

Today the instance of mental illness in our population is growing rapidly. New diagnoses are being identified daily and millions of prescriptions for psycho pharmaceuticals are written every hour. The rate of suicide amongst all age groups has increased substantially as the pressure of our face paced, hyper driven society also increases. Yet there are still very few options for those who truly experience a mental health crisis on a regular basis. That being said, Worcester State Hospital in Massachusetts has chosen a different route to redevelopment. Rather than turn the Kirkbride into luxury housing, the state of Massachusetts is building a multimillion dollar psychiatric facility that will provide 326 beds to both adolescents and adults. It is the largest capital construction expenditure in Massachusetts history and the first psych facility to be constructed in the state in over fifty years.

This begs the question as to whether or not history is indeed repeating itself. Are we cycling towards an era of re-institutionalization? Will we suddenly recognize the need for these safe havens to serve those who cannot function in society? It remains to be seen just how much we have learned from this bleak and often humiliating asylum past as we continue to wipe out the remnants of the story. For each asylum we tear down and redevelop, we have lost a page of our national history that we will never see again. There will never be another Kirkbride built with grand Victorian architecture, hand carved wood, and wrought iron accents. We will never again see a self sufficient hospital community like Kings Park Psychiatric Center in New York which resembled a small city unto itself. But will we see another pioneer in the treatment of mental illness and see change brought about to the conditions under which these patients are treated? Those in the field hope that we will indeed see just that as we continue to question our past in order to produce a more effective future for mental health patients.