-
Introduction
This timeline encompasses the following developments: 1) Origins of the first asylum in America 2) The influence of the European approach to asylum design and philosophy in early 19th century America 3) Dorothea Dix's influence as a reformer of the state asylum system in the middle of the century 4) The Kirkbride plan and the battle between moral approach and psychiatric/medical approach 5) The consequences of the rise of psychiatry at the turn of the century and beyond. -
Opening of the Pennsylvania Hospital
1) The Pennsylvania Hospital opens to treat the sick poor, motivated by Quaker moral imperatives and enlightenment scientific inquiry. 2) By the turn of the century, the West wing became dedicated to housing and treating the mad - effectively creating the first asylum in America. 3) Many of the issues we'll cover here - including overcrowding, inhumane treatment of patients, confinement vs. care, and the moral vs. medical approach - originate in the West wing of the Pennsylvania Hospital. -
European Influence, Individualism, Moral Treatment
With the opening of the York Retreat in England, William Tuke was one of many Europeans who developed and promoted the moral approach. This approach focused on providing work, recreation, and intellectual and religious activities that highlighted the need to treat patients as rational individuals, with the goal of reintegration into society. The documented success of this approach reached America, and influenced the design and philosophy of asylums opening in the first half of the 19th century. -
Dorothea Dix
By 1841, 16 asylums had opened in the Northeastern US. In the same year, Dorothea Dix, witnessing the atrocities still plaguing asylums and patients, became an important figure in asylum reform and patient advocacy. Dix’s advocacy and leadership created waves throughout the field of asylums and mental health treatment, ushering in a uniform campaign of progressive reform with the ultimate goal of healing. Dix was eulogized as “the most useful and distinguished woman America has yet produced.” -
The Kirkbride Plan
The Kirkbride Plan was a system of design for asylums across the country assembled by Thomas Kirkbride. Kirkbride, the superintendent of the Pennsylvania asylum at this time, was a strong proponent of moral treatment. This architectural plan laid great emphasis on long sunlit wings of asylums, comfortable living quarters, and aesthetically pleasing gardens and grounds. Since the publishing of this design, over 50 asylums have been constructed following Kirkbride’s strategy. -
Rise of Scientific Psychiatry
By the end of the 19th century, the long standing moral approach of the Kirkbride Plan had lost support from the American Medico-Psychological Association, marking a transition to medical and psychiatric care and treatment of the insane. The argument behind this transition was that asylum superintendents lacked the knowledge and skills needed to treat the insane, and that a scientific psychiatric approach would both serve the patients while promoting the advancement of psychiatric research. -
Consequences of Psychiatric Approach
In the first half of the 20th century, the number of patients in American asylums increased from 150,000 to 490,000. Many of the horrors we associate with asylums are rooted in this era - the explosion of inmates overwhelmed the asylums, leading to overcrowding, poor conditions and treatment, and a regression back to focusing on containment rather than treatment. People suffering from non-psychiatric conditions, such as syphilis, senility, and alcohol and drug addiction, ended up in asylums. -
Conclusion
The function of asylums and the approach to treating the mentally ill shifted drastically throughout U.S. history. The Pennsylvania Hospital intended to serve the sick poor and advance medicine. These hopes didn’t pan out, and reformers such as Dorothea Dix observed this and sought to improve the state of asylums. Advancements in scientific psychiatry and its use in treatment was a pivotal transition in the history of asylums, leading to a rapid increase in patients and inhumane treatment. -