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Kirkbride Plan

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The Kirkbride Plan was a system of mental asylum design advocated by American psychiatrist Thomas Story Kirkbride (1809–1883) in the mid-19th century. The asylums built in the Kirkbride design, often referred to as Kirkbride Buildings (or simply Kirkbrides), were constructed during the mid-to-late-19th century in the United States.

An 1848 lithograph of the Kirkbride design of Trenton State Hospital in Trenton, New Jersey
The Traverse City State Hospital in Michigan, in operation from 1881 to 1989, is an example of a Kirkbride building

The structural features of the hospitals as designated by Kirkbride were contingent on his theories regarding the healing of the mentally ill, in which environment and exposure to natural light and air circulation were crucial. The hospitals built according to the Kirkbride Plan would adopt various architectural styles,[1] but had in common the "bat wing" style floor plan, housing numerous wings that sprawl outward from the center.[2]

The first hospital designed under the Kirkbride Plan was the Trenton State Hospital in Trenton, New Jersey by John Notman, constructed in 1848.[3] Throughout the remainder of the nineteenth century, numerous psychiatric hospitals were designed under the Kirkbride Plan across the United States. By the twentieth century, popularity of the design had waned, largely due to the economic pressures of maintaining the immense facilities, as well as contestation of Kirkbride's theories amongst the medical community.

Numerous Kirkbride structures still exist, though many have been demolished or partially-demolished and repurposed.

At least 30 of the original Kirkbride buildings have been registered with the National Register of Historic Places in the United States, either directly or through their location on hospital campuses or in historic districts.

History

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Basis and philosophy

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Thomas Story Kirkbride, creator of the Kirkbride Plan

The establishment of state mental hospitals in the U.S. is partly due to reformer Dorothea Dix, who testified to the New Jersey legislature in 1844, vividly describing the state's treatment of lunatics; they were being housed in county jails, private homes, and the basements of public buildings. Dix's effort led to the construction of the New Jersey State Lunatic Asylum, the first complete asylum built on the Kirkbride Plan.[4]

Thomas Story Kirkbride (1809–1883), a psychiatrist from Philadelphia, Pennsylvania, developed his requirements of asylum design based on a philosophy of Moral Treatment[5] and environmental determinism.[6] The typical floor plan, with long rambling wings arranged en echelon (staggered, so each connected wing received sunlight and fresh air), was meant to promote privacy and comfort for patients. The building form itself was meant to have a curative effect, "a special apparatus for the care of lunacy, [whose grounds should be] highly improved and tastefully ornamented."[7] The idea of institutionalization was thus central to Kirkbride's plan for effectively treating the insane.[8]

Design and architectural features

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The floor plan for the Kirkbride design from an 1854 lithograph

The Kirkbride Plan asylums tended to be large, imposing institutional buildings,[9] with the defining feature being their "narrow, stepped, linear building footprint" featuring staggered wings extending outward from the center, resembling the wingspan of a bat.[10] The standard number of wings for a Kirkbride Plan hospital was eight,[11] with an accommodation of 250 patients.[12] Kirkbride's philosophy behind the staggered wings was to allow individual corridors open to sunlight and air ventilation through both ends, which he believed aided in healing the mentally ill.[10] Each wing, according to Kirkbride's original guidelines, would house a separate ward, which would contain its own "comfortably furnished" parlor, bathroom, clothes room, and infirmary, as well as a speaking tube and dumbwaiter to allow open communication and movement of materials between floors.[13][14] The wings furthest from the center complex of the building were reserved for the "most excitable," or most physically dangerous and volatile patients.[10] Patient rooms were suggested to be spacious, with ceilings "at least 12 feet (3.7 m) high," but only large enough to room a single person.[15] The center complexes of the Kirkbride Plan buildings were designed to house administration, kitchens, public and reception areas, and apartments for the superintendent's family.[16] Architectural styles of Kirkbride Plan buildings varied depending on the appointed architect, and ranged from Richardsonian Romanesque to Neo-Gothic.[17]

In addition to the intricate building design, Kirkbride also advocated the importance of "fertile" and spacious landscapes on which the hospitals would be built, with views that "if possible, should exhibit life in its active forms."[17] Kirkbride also suggested the hospital grounds be a minimum of 100 acres (40 ha) in size.[18][17] The foliage and farmlands on the hospital grounds were sometimes maintained by patients as part of physical exercise and/or therapy.[17] Over the course of the nineteenth and twentieth centuries, the campuses of these hospitals often evolved into sprawling, expansive grounds with numerous buildings.[17]

Operations and staffing

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Salaries per annum (1854)[19]
Position Compensation (USD)
Physician-in-chief $1,500–2,500
Assisting physicians $300–$500 + board
Steward $500
Supervisors $175–250
Engineer $240
Carpenter $240
Teachers $175–200
Carriage driver $168
Farmers & gardeners $144–200
Attendants $108–168
Cooks & bakers $100–150
Nightwatchmen $108
Seamstresses $96
 
A child, ostensibly of the physician-in-chief, swinging on the lawn of the Oregon State Hospital, c. 1900

In his proposal, Kirkbride outlined specific guidelines as to how a Kirkbride Plan hospital should be staffed and operate on a daily basis. Kirkbride suggested a total of 71, all of whom were required to live within, or in the immediate vicinity of, the hospital.[19] The superintending physician, or physician-in-chief, was required to live in the main hospital or in a building contiguous to it,[20] while his family had the option of residing at the hospital or seeking private lodging.[19] The staff was also to have a balanced gender distribution, with approximately 36 female and 35 male staff members.[19]

Among the staff of a Kirkbride Plan hospital were the superintending physician, an assisting physician and nurses, supervisors and teachers of each sex, a chaplain, matron, and a nightwatchman.[21] Kirkbride urged that at least two attendants be working in each ward at any given time, and stressed the importance of the superintendent's "proper selection" of attendants, given the extent of their management responsibilities:[22] "The duties of attendants, when faithfully performed, are often harassing, and in many wards, among excited patients, are peculiarly so. On this account pains should always be taken to give them a reasonable amount of relaxation and their position should, in every respect, be made as comfortable as possible."[23] For general labor at the hospital, he suggested that the able-minded patients help maintain the hospital grounds and assist in duties in their respective wards.[12]

Kirkbride's estimation of the number of staff as well as their respective compensations was outlined in an 1854 publication on the Kirkbride Plan design. He proposed a living wage for all employees of the hospital, noting that "although in a few institutions a liberal compensation is given, in many, the salaries are quite too low, and entirely inadequate to be depended on, to secure and retain the best kind of talent for the different positions. The services required about the insane, when faithfully performed, are peculiarly trying to the mental and physical powers of any individual, and ought to be liberally paid for."[24] Salary for the superintending physician according to the 1854 guideline was to be USD$1,500 (equivalent to $50,867 in 2023) if the physician's family resided at the hospital, and $2,500 (equivalent to $84,778 in 2023) if they found lodging at a private residence.[19] In addition to the medical staff and attendants, the Kirkbride Plan hospitals also employed laborers of various trades, including resident engineers, carpenters, cooks and dairymaids, gardeners, seamstresses, ironworkers, clothing launderers, and a carriage driver.[19]

Decline and phasing out

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By the late nineteenth century, the Kirkbride design had begun to wane in popularity, largely because the hospitals, which were state-funded, had received significant budget cuts that rendered them difficult to maintain.[25] General psychiatric and medical opinion of Kirkbride's theories regarding the "curability" of mental illness were also questioned by the medical community.[26]

Future

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Status

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Sites of current and former Kirkbride Hospitals in the United States
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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Surviving Kirkbride Plan buildings (either partial or complete) in the United States as of 2017[a]

A total of 73 known Kirkbride Plan hospitals were constructed throughout the United States between 1845 and 1910.[27] As of 2016, approximately 33 of these identified Kirkbride Plan hospital buildings still exist in their original form to some degree:[b] 24 have been preserved indicating that the building is still standing and still in use, at least, in part. 11 of the 24 preserved properties received secondary condition codes of deteriorating, vacant, partial demolition or a combination, while the remaining nine have been adaptively reused.[29] Of the 40 hospital buildings that no longer exist (either via demolition or destruction from natural occurrences, such as earthquakes), 26 were demolished to be replaced with new facilities.[29]

The highest concentrations of Kirkbride Plan hospitals were in the Northeast and Midwestern states.[30] Fewer Kirkbride Plan hospitals were constructed on the West Coast: In California, the Napa State Hospital was a notable Kirkbride Plan hospital, though the original structure was severely damaged during the 1906 San Francisco earthquake, and was ultimately demolished.[31] The two surviving Kirkbride structures on the West Coast are both located in the state of Oregon, at the Oregon State Hospital, and the Eastern Oregon State Hospital, the latter of which now houses the Eastern Oregon Correctional Institution.[32] While the vast majority of Kirkbride hospitals were located in the United States, similar facilities were built in Canada, and the Callan Park Hospital for the Insane in Sydney, Australia (constructed in 1885) was also influenced by Kirkbride's design.[33]

Preservation efforts

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Demolition of the Danvers State Hospital in Danvers, Massachusetts, 2007

Due to their intricate architectural features and historical significance, Kirkbride Plan hospitals have attracted conservation efforts from local and national groups, and (as of 2016) approximately 30 of the buildings have been registered with National Register of Historic Places.[34] Local conservation groups and historical societies have made attempts to save numerous Kirkbrides from demolition: The Danvers State Hospital in Danvers, Massachusetts is one example, in which a local historical society filed a lawsuit in 2005 to stall demolition of the building.[35] The majority of the Danvers State Hospital was demolished in 2007 in spite of the lawsuit, with only the center portion of the building receiving restoration and conversion into apartments.[35] The Northampton State Hospital in Northampton, Massachusetts, was demolished in 2006.[36]

Many of the surviving Kirkbride Plan buildings in the United States have undergone at least partial demolition and have been repurposed, often with the center portions of the buildings being most commonly preserved. The center complexes of the Hudson River State Hospital[37][38] in Poughkeepsie, New York, and the Oregon State Hospital in Salem, Oregon, for example, have been retained in spite of the majority of the outermost wings being demolished. One such Kirkbride Plan facility that has survived in its entirety is the Trans-Allegheny Lunatic Asylum, though does not contemporarily function as an active hospital. As of 2023, Trans-Allegheny Lunatic Asylum has not undergone demolition.[39]

Several facilities originally established as Kirkbride Plan hospitals are still active in the 21st century, though not all have retained the original Kirkbride buildings on their campuses. The Oregon State Hospital, the longest continuously operated psychiatric hospital on the West Coast, retained the majority of its original Kirkbride building during a 2008 demolition, seismically retrofitting and repurposing it as a mental health museum in 2013.[40]

Notable Kirkbride hospitals

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United States

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Built Name Location Status Notes NRHP # Ref.
1848 Trenton State Hospital Trenton, New Jersey Active The first Kirkbride Plan building — [41]
1848 Central State Hospital Indianapolis, Indiana Inactive One Kirkbride building, the Department for Women (1878), demolished 1970s — [42]
1848 Jacksonville State Hospital Jacksonville, Illinois Inactive Original Kirkbride building demolished 1970 75000669 [43]
1851 Harrisburg State Hospital Harrisburg, Pennsylvania Inactive Original Kirkbride building demolished 1893 86000057 [43]
1853 Taunton State Hospital Taunton, Massachusetts Demolished 2009 93001484 [44]
1854 Western State Hospital Hopkinsville, Kentucky Active Destroyed by fire in 1861; interiors rebuilt 79003612 [45]
1854–66[c] Maine Insane Hospital Augusta, Maine Inactive Original construction was not a Kirkbride; however, it was converted between 1854 and 1866 82000754 [46]
1855 Jackson State Hospital Jackson, Mississippi Inactive Original Kirkbride building demolished; campus now houses University of Mississippi Medical Center — [47]
1855 Dayton State Hospital Dayton, Ohio Inactive Repurposed as assisted living facility 79001902 [48]
1855 St. Elizabeths Hospital Washington, D.C. Active Kirkbride now serves as DHS HQ 79003101 [49][50]
1856 Austin State Hospital Austin, Texas Active Original Kirkbride building houses administrative offices 87002115 [51]
1858 Northampton State Hospital Northampton, Massachusetts Demolished 2006 94000696 [52]
1858 Mendota Mental Health Institute Madison, Wisconsin Active Original Kirkbride building demolished 1964 — [53]
1859 The Institute of the Pennsylvania Hospital Philadelphia, Pennsylvania Inactive 66000684 [54]
1859 Kalamazoo Regional Psychiatric Hospital Kalamazoo, Michigan Inactive Original Kirkbride building demolished — [55]
1859 Bryce Hospital Tuscaloosa, Alabama Inactive Sold to the adjacent University of Alabama and partially demolished (main part saved) 77000216 [56]
1862 Dixmont State Hospital Pittsburgh, Pennsylvania Demolished 2005 80003401 [57]
1863 Trans-Allegheny Lunatic Asylum Weston, West Virginia Inactive Formerly known as Weston State Hospital 78002805 [58]
1865 Mount Pleasant State Hospital Mount Pleasant, Iowa Destroyed 1936 Original Kirkbride building destroyed in fire — [59][60]
1866 St. Peter State Hospital
(now Minnesota Security Hospital) 		St. Peter, Minnesota Active Majority of original Kirkbride building demolished — [52]
1868 Hudson River State Hospital Poughkeepsie, New York Inactive Undergoing demolition as of 2016; portion of original Kirkbride building preserved 89001166 [37]
1868 Osawatomie State Hospital Osawatomie, Kansas Active Original Kirkbride building demolished between 1971 and 2002 — [61]
1869 Anna State Hospital Anna, Illinois Inactive Administration section of original Kirkbride building remains and is in use — [62]
1869 Central State Hospital Anchorage, Kentucky Demolished 1996 83002646 [63][47]
1869 Danville State Hospital Danville, Pennsylvania Active Original Kirkbride building preserved and in use — [64]
1870 Central State Hospital Petersburg, Virginia Active Original Kirkbride building demolished — [65]
1870 Buffalo State Hospital Buffalo, New York Inactive Original Kirkbride building restored and subdivided by State of New York for public use 73001186 [66]
1872 Spring Grove State Hospital Catonsville, Maryland Demolished 1963 — [67]
1872 Elgin State Hospital Elgin, Illinois Active Original Kirkbride building demolished 1993 — [68]
1872 Topeka State Hospital Topeka, Kansas Demolished 2010 — [69]
1873 Winnebago State Hospital Oshkosh, Wisconsin Active Original Kirkbride demolished in stages between 1950 and 1969 — [47]
1873 Independence State Hospital Independence, Iowa Active — [44]
1874 Athens Lunatic Asylum Athens, Ohio Inactive Renovated and repurposed by Ohio University 80002936 [70]
1874 Warren State Hospital Warren, Pennsylvania Active — [71]
1876 Greystone Park Psychiatric Hospital Hanover, New Jersey Active Original Kirkbride building demolished 2015 — [72]
1876 Napa State Hospital Napa, California Active Original Kirkbride building demolished 1949 — [31]
1877 Columbus State Hospital Columbus, Ohio Demolished 1991 — [73]
1877 Worcester State Hospital Worcester, Massachusetts Active demolished 80000530 [44]
1878 Danvers State Hospital Danvers, Massachusetts Demolished 2006 Center exterior of Kirkbride building preserved 84002436 [44]
1878 Pontiac State Hospital Pontiac, Michigan Demolished 2000 81000315 [74]
1879 Kankakee State Hospital Kankakee, Illinois Active Original Kirkbride building preserved — [75][43]
1883 Oregon State Hospital Salem, Oregon Active Original Kirkbride building repurposed as mental health museum 08000118 [40]
1883 Broughton Hospital Morganton, North Carolina Active 77000996 [65]
1883 Arkansas State Hospital Little Rock, Arkansas Active Kirkbride building demolished 1963 — [76][77]
1884 Clarinda State Hospital Clarinda, Iowa Inactive — [57]
1885 Northern Michigan Asylum Traverse City, Michigan Inactive Center of main building demolished and replaced in 1963, remainder renovated and in use as condos and businesses 78001499 [78]
1885 Agnews State Hospital Santa Clara, California Inactive Original Kirkbride building destroyed in 1906 earthquake; partially rebuilt in 1910 97000829 [44]
1885 Terrell State Hospital Terrell, Texas Active Original Kirkbride building demolished — [65]
1887 Nevada State Hospital Nevada, Missouri Demolished 1999 — [44]
1890 Cherokee Mental Health Institute Cherokee, Iowa Active — [44]
1891 Sheppard Pratt Hospital Towson, Maryland Active 71000369 [79]
1891 Eastern State Hospital Medical Lake, Washington Active Original Kirkbride building demolished — [80]
1892 San Antonio State Hospital San Antonio, Texas Active Originally Named Southwestern Insane Asylum until 1925. Original Kirkbride building demolished and replaced in the 1970's — [81]
1893 Patton State Hospital San Bernardino, California Active Original Kirkbride building demolished — [82]
1894 St. Vincent's Hospital Normandy, Missouri Inactive Original Kirkbride building repurposed as apartment building 82004722 [83]
1895 Fergus Falls Regional Treatment Center Fergus Falls, Minnesota Inactive 86001386 [84]
1913 Eastern Oregon State Hospital Pendleton, Oregon Inactive Houses Eastern Oregon Correctional Institution as of 1983 — [85]

Outside the United States

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Built Name Location Status Notes Ref.
1858 Nova Scotia Hospital Halifax, Nova Scotia, Canada Active Original Kirkbride building demolished 1996 [d]
1885 Callan Park Hospital for the Insane Lilyfield, New South Wales, Australia Inactive Original Kirkbride building preserved; campus houses Sydney College of the Arts [33]
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Numerous Kirkbride Plan hospitals and buildings have been featured in the arts: the Danvers State Hospital in Danvers, Massachusetts was both the setting and primary filming location for the 2001 psychological horror film Session 9.[35] It has also been suggested by historians as an inspiration on H. P. Lovecraft, and in turn an inspiration for the fictional setting Arkham Asylum in the various Batman series.[87] The Oregon State Hospital was also featured as the primary filming location for the film One Flew Over the Cuckoo's Nest (1975),[88] and was also the setting of "Ward 81," a 1976 series of photographs by photographer Mary Ellen Mark.[89]

The Trans-Allegheny Lunatic Asylum in West Virginia was featured on the Travel Channel reality series Ghost Adventures.[90]

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† demolished

Notes

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  1. ^ Based on research from KirkbrideBuildings.com as well as other cited external sources, there are at least 25 surviving Kirkbride Plan buildings in the United States.
    • Note: This does not reflect the current existence of active hospitals originally established under the Kirkbride Plan, only the survival of the original buildings.[9]
  2. ^ Per the sourced table, many Kirkbride Plan hospitals still exist in some form (some as active hospitals), though the original Kirkbride structures have not been retained on many of the hospital campuses over the course of their evolution. Other hospitals have been closed down and demolished entirely, while some have been demolished in part and/or repurposed for various uses.[28]
  3. ^ The original hospital layout during its 1840 construction was not in the Kirkbride Plan, as it pre-dates it. However, after an 1850 fire destroyed part of the building,[46] reconstruction converted the main hospital into a Kirkbride.
  4. ^ Per a c. 1858 lithograph of the Nova Scotia Hospital floor plan, the hospital's original building was modeled after the Kirkbride Plan. The Nova Scotia Hospital is also referenced in footnotes of The Architecture of Madness: Insane Asylums in the United States (2007) as being influenced by the Kirkbride Plan; however, its "double-loaded hallways" were a noted modification on the Kirkbride design.[86]

References

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  1. ^ Yanni 2007, p. 149.
  2. ^ "About Kirkbride Buildings". Kirkbride Buildings. Retrieved May 9, 2017.
  3. ^ Yanni 2007, pp. 52–59.
  4. ^ Goeres-Gardner 2013, p. 33.
  5. ^ Yanni 2007, p. 11.
  6. ^ Harvilla, Lindsay (2010). "Therapeutic Architecture". The Pennsylvania Center of the Book. Retrieved May 12, 2017.
  7. ^ Yanni 2007, p. 56.
  8. ^ Yanni 2007, pp. 55–59.
  9. ^ a b "The Buildings". Kirkbride Buildings. Retrieved May 9, 2017.
  10. ^ a b c Verderber 2010, p. 25.
  11. ^ Kirkbride 1854, p. 32.
  12. ^ a b Kirkbride 1854, p. 51.
  13. ^ Kirkbride 1854, p. 14.
  14. ^ Kirkbride 1854, p. 57.
  15. ^ Kirkbride 1854, p. 15.
  16. ^ Kirkbride 1854, p. 12.
  17. ^ a b c d e Verderber 2010, p. 26.
  18. ^ Kirkbride 1854, p. 7.
  19. ^ a b c d e f Kirkbride 1854, p. 53.
  20. ^ Kirkbride 1854, p. 54.
  21. ^ Kirkbride 1854, pp. 44–50.
  22. ^ Kirkbride 1854, p. 48.
  23. ^ Kirkbride 1854, p. 49.
  24. ^ Kirkbride 1854, p. 52.
  25. ^ Verderber 2010, pp. 26–27.
  26. ^ Verderber 2010, p. 27.
  27. ^ Murphy 2016, p. 35.
  28. ^ Murphy 2016, pp. 38–42.
  29. ^ a b Murphy 2016, p. 37.
  30. ^ Murphy 2016, p. 42.
  31. ^ a b Ryan, David (December 2, 2005). "At 130 years, Napa State Hospital is leading reforms in mental health". Napa Valley Register. Retrieved May 10, 2017.
  32. ^ Aney, Kathy (February 18, 2014). "Century-old Pendleton mental health hospital prepares to shut down". The Bend Bulletin. Retrieved May 10, 2017.
  33. ^ a b "Kirkbride: Past & Present" (PDF). Sydney College of the Arts. University of Sydney. August 2005. Retrieved May 11, 2017.
  34. ^ Murphy 2016, p. 46.
  35. ^ a b c Cassidy, Chris (November 9, 2005). "Bad News for Danvers State Hospital". Salem News. Retrieved May 10, 2017 – via Opacity.
  36. ^ "Northampton State hospital's history shared in images". The Republican. November 26, 2014. Retrieved May 10, 2017 – via MassLive.
  37. ^ a b Horrigan, Jeremiah (July 28, 2016). "Ground broken for development at former Hudson River Psychiatric Center". Hudson Valley One. Retrieved May 9, 2017.
  38. ^ Penny, Daniel (April 6, 2016). "The Lovely Bones: Renovating the Kirkbride Asylums Means Finding New Ways to Live With Old Ghosts". The Village Voice. Retrieved May 12, 2017.
  39. ^ "Trans-Allegheny Lunatic Asylum – Historic and Paranormal Tours".
  40. ^ a b Goeres-Gardner 2013, p. 11.
  41. ^ Yanni 2007, p. 55.
  42. ^ Davis, Victoria T. (September 24, 2015). "Inside Indy's 'insane asylum'". Indianapolis Recorded. Retrieved May 9, 2017.
  43. ^ a b c Murphy 2016, p. 125.
  44. ^ a b c d e f g Murphy 2016, p. 126.
  45. ^ Hurd 1916, p. 461.
  46. ^ a b "Augusta Mental Health Institute Timeline: 1840–2004". Maine.gov. Retrieved May 10, 2017.
  47. ^ a b c Murphy 2016, p. 127.
  48. ^ Rickey, Lisa (October 22, 2013). "Dayton State Hospital". Dayton Daily News Archive. Wright State University. Retrieved May 11, 2017.
  49. ^ "St. Elizabeths Hospital". Kirkbride Buildings. Retrieved May 10, 2017.
  50. ^ Moerson, Maria Elena (October 30, 2015). "Finding Asylum: Tracing the evolution of five Kirkbride Planned hospitals for the insane". The Architects Newspaper. Retrieved May 12, 2017.
  51. ^ "History of the Austin State Hospital". Texas Department of State Health Services. Retrieved May 10, 2017.
  52. ^ a b Hurd 1916, p. 848.
  53. ^ Public Documents of the State of Wisconsin. Wisconsin Laws, Statutes, etc. 1858 – via Google Books.  
  54. ^ "Pennsylvania Hospital History". History of Pennsylvania Hospital. University of Pennsylvania. Retrieved May 9, 2017.
  55. ^ Hurd 1916, p. 768.
  56. ^ Hurd 1916, p. 5.
  57. ^ a b Hochman, Louis C. (May 31, 2015). "From the archives: Kirkbride buildings, built to foster sanity, now empty hulks". NJ.com. Retrieved May 10, 2017.
  58. ^ Murphy 2016, p. 76, 128.
  59. ^ Hurd 1916, p. 204.
  60. ^ Hoopes 2015, p. 126.
  61. ^ Hoopes 2015, p. 111.
  62. ^ Yanni 2007, p. 165.
  63. ^ Hurd 1916, p. 462.
  64. ^ "Timeline of the Hospital". Danville State Hospital. Thomas Industries. Retrieved May 10, 2017.
  65. ^ a b c Murphy 2016, p. 128.
  66. ^ Murphy 2016, pp. 72–3.
  67. ^ "Spring Grove History". Maryland Department of Health and Mental Hygiene. Retrieved May 9, 2017.
  68. ^ Briska, William H. (1997). The History of Elgin Mental Health Center: Evolution of a State Hospital. Crossroads Communications. ISBN 0-916445-45-3.
  69. ^ Hurd 1916, p. 434.
  70. ^ Riely, Logan (October 15, 2015). "Old Athens insane asylum to get new life as part of Ohio University". The Columbus Dispatch. Retrieved May 10, 2017.
  71. ^ "Warren State Hospital". Pennsylvania Department of Public Welfare. Archived from the original on April 26, 2007. Retrieved June 7, 2007.
  72. ^ Westhoven, William (May 15, 2015). "Greystone: History reduced to rubble". Daily Record. Retrieved May 9, 2017.
  73. ^ "Columbus State Hospital". Ohio State University Library. September 26, 2011. Retrieved May 9, 2017.
  74. ^ Hurd 1916, p. 781.
  75. ^ Hurd 1916, p. 222.
  76. ^ Goff, April. "Arkansas State Hospital". Encyclopedia of Arkansas. Retrieved May 9, 2017.
  77. ^ "Arkansas Lunatic Asylum – Arkansas's Forgotten Asylum". Retrieved March 2, 2021.
  78. ^ Murphy 2016, pp. 70–1.
  79. ^ Yanni 2007, p. 178.
  80. ^ "Eastern State Hospital". Spokesman-Review. July 4, 2016. Retrieved May 10, 2017.
  81. ^ "San Antonio State Hospital". Texas-State-Historical-Association. February 10, 2021 [1976]. Retrieved April 20, 2024.
  82. ^ Hurd 1916, p. 50.
  83. ^ Murphy 2016, p. 64.
  84. ^ Engstrom, Tim (October 18, 2016). "Kirkbride Building tour prepares officials". The Fergus Falls Journal. Retrieved May 10, 2017.
  85. ^ Goeres-Gardner 2013, p. 7.
  86. ^ Yanni 2007, p. 172.
  87. ^ Packer, Sharon (2012). Cinema's Sinister Psychiatrists: From Caligari to Hannibal. McFarland. p. 208. ISBN 978-0-786-49241-1.
  88. ^ Johnson, Kirk (March 31, 2013). "Once a 'Cuckoo's Nest,' Now a Museum". The New York Times. Retrieved May 7, 2017.
  89. ^ Goeres-Gardner 2013, p. 244.
  90. ^ "Ghost Adventures: Trans Allegheny Lunatic Asylum". The Travel Channel. Retrieved May 11, 2017.

See Yanni, The Architecture of Madness, introduction, for more on environmental determinism.

Works cited

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Further reading

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  • Tomes, Nancy (1994). The Art of Asylum-Keeping: Thomas Story Kirkbride and the Origins of American Psychiatry. University of Pennsylvania Press. ISBN 978-0-8122-1539-7.
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