An orthodox Quaker, Dr. Kirkbride was a trained physician who considered a hospital’s daily workings and flows of activity from a physiological perspective, yet the provision of abundant light and fresh air for every patient room was both scientifically and spiritually significant. Hygienically maintained and generously proportioned buildings, sited in soothing settings for walks, pleasure and occupational therapy, were all part of Kirkbride’s commitment to beauty-as-therapy and the respectful care known as “moral treatment,” steeped in Quaker sensibilities (R. Kirkbride, 2024). In his writings, Dr. Kirkbride navigates several contradictory forces, often simultaneously, including science/spirituality, pragmatism/idealism, and the respective points of view of both patients and society. This is especially true in his frequent pairing of thrift with “tasteful” ornament. “Although it is not desirable to have an elaborate or costly style of architecture,” he cautions, “it is, nevertheless, really important that the building should be in good taste, and that it should impress favorably not only the patients, but their friends and others who may visit it” (T.S. Kirkbride 1854, 11). Consistently, Kirkbride establishes a nuanced position: one must avoid ornamental extravagance on the one hand yet also recognize its beneficial influences for patients in “such an amount of it as is required by good taste.” Who was to determine how much ornament was savory or unsavory?

According to Kirkbride, the role of a hospital architect was to ornament and style the physical envelope of the building — with “good taste,” yet not too “elaborate or costly” — while the operational layout and workings were determined by an experienced superintendent (R. Kirkbride 2024). Exterior architectural features, especially the hospital’s roofscape, were the proper domain of an architect, providing patients and local communities with memorable, signature features. Kirkbride asserts: “the style of dome for the centre building, and the varied forms of termination of the several ventilating shafts, are left as drawn by the architect, with the single remark that if deemed expedient, they may be replaced by less costly arrangements” (T. S. Kirkbride 1880, 130). The central main administrative building, so pivotal to the arrivals of patients and visitors, as well as the seat of daily operations, offered another opportunity to balance the wisdom of prudence and the wisdom of taste. “The centre building ought to be the prominent feature in such a structure as that under consideration,” he writes, “and while there can be no excuse for squandering money simply for display, or for giving it unnecessarily large proportions, like all other parts, it should be in good taste and have ample and comfortable accommodations for the convenient transaction of such business as necessarily belongs to it, and for the apartments of the officers, who are expected to reside in it. Not to do this, is neither wisdom nor economy” (T. S. Kirkbride 1880, 53).

Dr. Kirkbride is mindful of the first impressions on arrival at a hospital. “The grounds about the building should be highly improved and tastefully ornamented; a variety of objects of interest should be collected around it, and trees and shrubs, flowering plants, summerhouses, and other pleasing arrangements, should add to its attractiveness. No one can tell how important all these may prove in the treatment of patients, nor what good effects may result from first impressions thus made upon an invalid on reaching a hospital, – one who perhaps had left home for the first time, and was looking forward to a gloomy, cheerless mansion, surrounded by barren, uncultivated grounds for his future residence, but on his arrival finds everything neat, tasteful and comfortable” (T. S. Kirkbride 1854, 12).

Over all, the terms “taste,” “tasteful,” and “tastefully” appear eight timesin the first edition of 1854. In the treatise’s second edition, in 1880, the occurrence of “taste” and its variants nearly doubles, appearing fourteen times. What was the source of this increase in sapor and sapience?

If not for his tragic death at the age of 36, in 1852, it is quite likely that A. J. Downing would have received many more commissions for Kirkbride Plan hospitals, around eighty of which were built across North America and Australia. Calvert Vaux, Downing’s partner at the time of his death, and Frederick Law Olmsted, the inheritor of Downing’s mantle in landscape design, were later commissioned to design the grounds for two Kirkbride hospitals that are now National Historic Landmarks, at Buffalo (1872) and Poughkeepsie, New York (1868). Downing’s personal endorsement of the Gothic and Italianate styles shaped the architectural language of numerous Kirkbride Plan hospitals, and his advocacy for tasteful architecture and landscape design clearly influenced Dr. Kirkbride, who writes: “Every hospital for the insane should possess at least one hundred acres of land, to enable it to have the proper amount for farming and gardening purposes, to give the desired degree of privacy and to secure adequate and appropriate means of exercise, labor and occupation to the patients, for all these are now recognized as among the most valuable means of treatment.” Of those hundred acres, “from thirty to fifty acres immediately around the buildings, should be appropriated as pleasure grounds, [of which] it is desirable that several acres of this tract should be in groves or woodland, to furnish shade in Summer, and its general character should be such as will admit of tasteful and agreeable improvements” (T.S. Kirkbride 1854, 7).

Material Histories

 

In addition to light and air, materials from the site and surroundings flowed into these structures. At Athens, OH, many of the 18.5 million bricks used to building the building and roads were made on site, excavated strategically to provide lakes for the pleasure grounds. And traces of old growth forests of American Chestnut, Maple, and Michigan White Pine are embedded in the trusses, joists and floors of many Kirkbrides. Their demolition is therefore not merely a question of releasing carbon unnecessarily, it’s an erasure of embodied energy and material intelligence. Materials also flowed from the interiors into the landscapes surrounding the hospitals. While Kirkbride does not say a word about death in his treatise, most of the hospital sites include cemeteries with thousands of unmarked graves that may remain long after the Kirkbride hospital has been demolished. In New York State alone it’s estimated there are 55,000 unmarked graves at current and former psychiatric hospitals.

 

Although we now have broader options to diagnose and treat mental illness than those available to Dr. Kirkbride and his colleagues, in a world facing intensifying disasters, pandemics, social and political unrest and injustices, there is still urgent need for places to go. As former head of NIMH, Thomas Insel, argues: “We need places like crisis-stabilization units, opportunities for people to spend maybe 23 hours, maybe seven days, to be able to recover from whatever the acute crisis is” (R. Kirkbride 2024). While there may be reasons not to restore an abandoned Kirkbride solely to its former use as mental health facility, it is worth noting that for conditions such as Post Traumatic Stress, patients benefit from recuperative places much like those conceived by Kirkbride, Downing and Olmsted, with their spacious, light-filled rooms and soothing, natural surroundings. At abandoned sites such as Fergus Falls, MN, whose Kirkbride was briefly a candidate to become a regional PTS treatment center several years ago, such an approach may be extremely pragmatic as part of a mixed-use redevelopment strategy. As successfully demonstrated at Kirkbrides elsewhere, including Traverse City, MI, and Athens, OH, such a blended strategy calls for the sapient good taste and judgment to redevelop with patience, in small bites rather than one big gulp, which, despite its (assumed) convenience, more often leads to indigestion than results worth savoring.

As historical documents, the remaining Kirkbride Plan hospitals embody invaluable lessons for current efforts to improve our mental healthcare. Coupled with the ecological imperative to adaptively reuse – and not squander – our existing infrastructures, it is critical to preserve and repurpose the hospitals. These two principles, combined with the urgency to broaden conversations about places with difficult memories, drive my efforts with PreservationWorks.

 

PreservationWorks

 

I am the Spokesperson and a founding trustee of PreservationWorks, a non-profit organisation committed to the preservation and adaptive reuse of the 35 remaining Kirkbride Plan hospitals across North America and Australia. We formed in 2015, absorbing the 501c3 charter of the advocacy group, Preserve Greystone, in the wake of the highly contested and unnecessary demolition of Greystone Park Psychiatric Hospital, in Morris Plains, NJ, which was ranked as one of the top five architectural losses in the United States that year by the National Trust of Historic Places. Our mission is to share knowledge and resources to support local efforts to reactivate and memorialize these structures and those who lived and worked in them through comprehensive photographic tours, events, and interactive research media on our website, such as the Kirkbride Navigator. Our impassioned network includes urban explorers and other non-traditional preservationists who embrace the challenging histories of Kirkbride Plan hospitals, mindful of their multifaceted value.

Links to sight-, scent-, and sound-based projects about the Kirkbride Plan hospitals

 

“Phantoms of the Kirkbride Hospitals” (Places Journal 2024), centers on Dr. Thomas Story Kirkbride’s vision for the patient-centered treatment of mental illness, shaped by respectful care and uniquely situated and configured hospitals. It reflects on the visual nature of Dr. Kirkbride’s therapies, which included innovative uses of photography and magic lantern shows, and soothing views to generously landscaped grounds; and it also considers the “optics” of their domestic décor, which, despite beneficent intent, often masked inherent tensions with institutional realities. The second project, “Scent Surveys, Decay and Transformation in the Kirkbride Plan Hospitals of North America,” a chapter for an upcoming book on experimental archaeology (UCL July 2025), investigates the multisensorial continuum between personal experience and cultural memory through the scent of decay. “Scent Surveys” considers the poignant olfactory encounters of ten explorer-preservationists with abandoned Kirkbride Plan hospitals, alongside the miasma theory that informed their characteristic layouts and innovative architectural and technological features. The third project, Sound the Asylum is an ongoing experimental documentation project by composer-producers Melissa Grey and David Morneau, using ambisonic spatial recordings of resonant frequencies to catalog the acoustical properties of rooms once inhabited by patients, caregivers, and visitors at several abandoned Kirkbride Plan hospitals.