The Surprising Second Life Of America’s Asylums

The sprawling mental hospitals of the 19th century, once vanguards of new ideas about architecture’s impact on wellness, are now being reborn.




The idea that physical spaces can enhance our mental health and well-being may feel like a progressive one. But in fact, it’s been around for well over a century. In 1880, a psychiatrist named Thomas Story Kirkbride published a treatise on the design of mental health hospitals promoting the notion that architecture could have a curative effect—or as he chose to call it, a “special apparatus for lunacy.”

The Kirkbride Plan, as it came to be known, was a major influence on 19th century health care reform, and the model for over 80 asylums across the country. During his lifetime, Kirkbride made architecture an inextricable part of mental health care in the U.S. His guidelines called for building grand, Victorian-style buildings on extensive grounds that often incorporated a working farm. Yet his ideas fell out of favor in the 20th century, as budget cuts and new ideas about mental health emerged. The many grand institutional buildings based on Kirkbride’s progressive ideas fell into decay, too. Some of the massive abandoned estates have become popular subjects of photography series documenting their decay, and others have been demolished.

As a new exhibition at the National Building Museum shows, still others are getting a second life through adaptive reuse. And as these buildings have been rehabilitated and his story retold, it’s becoming evident that Kirkbride’s overarching idea about architecture—which connected the design of a building with the health of its inhabitants—was ahead of its time.

The Center Building. Photograph, 2016. Plans to retain as much of the interior of the Center Building as possible were hampered by the discovery of original building materials and a structural system that were in far worse condition than expected. [Photo: © Colin Winterbottom]
The show, called Architecture of an Asylum, focuses on one Kirkbride building in particular: The federally operated St. Elizabeths Hospital in Washington, D.C. The hospital was established by Congress in 1855, thanks largely to Dorothea Dix, the most famous and influential psychiatric reformer at the time, who helped convince legislators of its need. Before Dix began lobbying vigorously for the construction of asylums across the U.S., it was typical for mentally ill people to be left in the inadequate care of families, or to wind up in jails, prisons, or run-down care facilities, where they were often misunderstood and mistreated.

While Dix was neither an architect nor a physician, she did understand the importance of design when it came to these spaces, so Kirkbride’s book became the unofficial guide for the architects of new asylums, designed to uphold the principles that the reform movement was built on. The pioneering St. Elizabeths was considered a model in this new wave of government-owned psychiatric facilities.

One fundamental aspect of the Kirkbride plan was the layout of the main building, which was designed in the shape of a “V,” like a bird in flight, with long wings that extended out on either side. The hospital’s superintendent, considered to be the institute’s “patriarch,” lived at the center of the building, an accessible distance from all other living quarters. Patient rooms were to be comfortable, with plenty of sunlight coming in through the windows. Kirkbride proposed that the imposing institutes be built on sprawling farmland, with crops, livestock, and barns where patients could work and have a sense of purpose while enjoying the benefits of the outdoors.


Most importantly, Kirkbride’s institutions were self-contained. They were their own communities set back from the rest of society, meant to offer respite. “[Kirkbride] believed strongly that if you could take mentally ill people away from destructive home lives and the stressors of city, put them in bucolic settings and give them fresh air, empathetic treatment, and work, that they would be cured,” says Sarah Leavitt, who curated the exhibition. 


Following an extensive renovation by the General Services Administration, the Center Building will be repurposed as offices for the Department of Homeland Security. [Photos: Courtesy of the U.S. General Services Administration]
From its first stages of construction in 1902 to the early 1960s, St. Elizabeths continued to add more buildings to the original Kirkbride structure, as the hospital took on more patients. It hit its peak in the early ’60s with 8,000 patients.

Yet soon after, public policy shifted toward community-based health care and open hospitals. The idea of a self-contained community for psychiatric care began to backfire in the second half of the 20th century, as facilities became overcrowded. Funds were cut intermittently between the ’40s and ’60s, especially during times of economic decline or war.

By the early ’60s, state-run asylums were synonymous with the declining, unhygienic, racially segregated, and socially isolated facilities like the one famously depicted in Ken Kesey’s 1962 novel One Flew Over the Cuckoo’s Nest. 

Oaks B, Sitting Room. Photograph, 1905. [Photo: Courtesy National Archives and Records Administration]
St. Elizabeths suffered the same fate as the other institutions across the country. The facilities were overcrowded and the staff overstretched. By 1962, the farm was only nominally functional. The hospital expanded the grounds and city privileges for patients, and added outpatient clinics, foster homes, and halfway houses, seeking to both provide less restrictive care, per the new outlook on mental health, and to reduce costs.


Another major factor in the deinstitutionalization of health care was the advent of psychotropic drugs. The use of drugs to manage mental illness underscores an important shift in thinking in the psychiatric community: These days we understand mental illness as a brain disorder, related to changes in the anatomy, physiology, and chemistry of the nervous system.

These medical developments also led to the understanding that mental illness could not be approached solely by thinking about outside environmental factors. This devalued Kirkbride’s notion that building and administering health care facilities by design could cure the patients inside of them.

Yet as Leavitt points out, aspects of Kirkbride’s Plan—like facilities with a healthy dose of sunshine, comfortable living areas, and bucolic settings—are still used in design today in a broader sense, to increase well-being and quality of life.

Perhaps that’s why St. Elizabeths has found a second life after years of patient decline and struggles with funding. In 2010, a brand-new consolidated hospital was built on the grounds. The U.S. General Services Administration (GSA) took over the rest of the mostly vacant grounds in 2004, and has since announced a master plan for office facilities for the Department of Homeland Security and the Coast Guard. Plans for the east campus, now owned by the city, call for new mixed-use neighborhoods that will include retail, offices, open space, and cultural amenities.

Even with construction still underway at St. Elizabeths, it seems clear that preserving these historical buildings can be a big boon for a city’s development. These buildings were built to house thousands of people and designed in a way that offered a sense of privacy and community. In most cases, the land is still owned by the city or state, and is located on the outskirts of a city. There are plenty of ways to repurpose them that alleviate housing shortages, or bring in industry and tourism. Take a former Kirkbride asylum in Buffalo, for example, which is leveraging Kirkbride’s design and the surrounding land for a luxury hotel and architecture center. The Oregon State Hospital, where One Flew Over A Cuckcoo’s Nest was filmed, has been turned into a Museum of Mental Health. Leavitt says that of the 80 Kirkbride hospitals around the country, 34 of them are still standing. It’s possible that we’ll see others repurposed in the years to come.

While Kirkbride’s theory that architecture itself can cure mental illness no longer fits into modern medical practices, the spaces he designed still offer insight into how the built environment can impact our well-being. In fact, Kirkbride’s broader idea that the design of our spaces is a critical part of our health is being explored in even more depth today—and some science backs it up. Research on the positive affects of sunlight and access to greenery on mood and stress levels has led architects to integrate them into environments more frequently. Studies also show that well-designed affordable housing and residential stability has a positive affect on health. New research even suggests that architecture could play a role in exposing us to good microbes, as well as shielding us from the bad ones.


Exploring the history of these 100-year-old psychiatric facilities and how they can be repurposed today opens up a conversation about designing for healthier spaces and even cities. We’re really just beginning to understand the degree to which architecture can impact human health—and the fact that Kirkbride’s architecture had merit beyond mental health makes it rife for rehabilitation today.

About the author

Meg Miller is an associate editor at Co.Design covering art, technology, and design.