Kirkbride Plan
en.wikipedia.org
en.wikipedia.org
But early Kirkbrides are a solution that I truly think could work today, even. And they could be highly affordable, too. A few quotes from the article:
> 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.
> 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.
> 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.
As far as I know, the original Kirkbrides were supposed to operate something like an English manor house (say, Downton Abbey): largely self-sufficient domiciles for a large number of people to live, work, play, grow food, learn skills, and grow old. Patients could achieve some level of autonomy by assisting with household chores, food growing, caring for animals, in a way that treats them like people. A far cry from the prison-like asylums of the 70s. I believe the original Kirkbrides were only designed for 50-100 patients -- later designs basically gave up everything that made a Kirkbride a Kirkbride except for some minor architecture accents.
In a world where communities are dying, where we don't know what to do with the mentally ill and drug addicted (and let them rot on the street as a "solution"), where we're constantly told that we can't offer treatment and healthcare to people because it's too expensive, these start to sound like a pretty damn good solution.
Currently our local celebrity billionaire, Jemal Douglas is continuing his storied Daddy Warbucks spending spree with the old Hotel Henry ( https://buffalonews.com/news/local/douglas-jemal-hoping-to-o... ). I work in his Seneca One Tower as part of the 43N (https://www.43north.org/) cohorts in startup land (my sole reason for being attached at the hip to YC news).
I've also had the distinct pleasure of being in MANY of the Kirkbrides over the years through a past hobby of Urbex (https://www.uer.ca - some may know it, but mostly dead community now). I think I've been to 6-7 of them over the last 10-15 years of doing that, and as a photographer and a history dork, they are astounding to see in person (and on occasion from the inside).
Now, back to a psychology degree and wandering into tech ... the obvious departure of the federal system after Pennhurst discoveries (https://www.imdb.com/title/tt1194153/ <- truly worth watching to gain a perspective on our failed mental health system) to the states, I know a lot about this stuff from the front end of photography to the backend of its history.
Being from Buffalo, and here for at least 25 years (most of my adult life) unique place to be on this particular topic.
Hoping this information helps this post alone, since it touches on so much of what I enjoy talking about when living here.
Also check out Henry Hobson Richardson and Fred Olmsted is a pretty interesting one.
Here are some more creepy things, for the more total black wardrobe folks out there (me included) - https://www.atlasobscura.com/lists/abandoned-psychiatric-hos...
Enjoy!
As someone with very little intent to ever get married, I always thought there's a small bit of humor to getting married... in an asylum. Because it does sound a tad crazy to me.
[0]https://en.wikipedia.org/wiki/Trans-Allegheny_Lunatic_Asylum
But at a time when we are clawing for reduced sentences for criminals, we are also lamenting the inability to detain people who haven't even done anything wrong.
The real reason we don't have institutions is that people dont want to be institutionalized.
You cannot reform the world to your picturesque ideal. It's been tried and it never turns out well. We can only build society to protect our rights and liberties.
> In 1907, Dr. Henry Cotton became the medical director. Believing that infections were the key to mental illness, he had his staff remove teeth and various other body parts that might become infected from the hospital patients. Cotton's legacy of hundreds of fatalities and thousands of maimed and mutilated patients did not end with his leaving Trenton in 1930 or his death in 1933; in fact, removal of patients' teeth at the Trenton asylum was still the norm until 1960.
If you want to know why the state “asylum” system was dismantled in the 70s look no further.
https://www.theatlantic.com/health/archive/2015/01/should-th...
But there's the rub. The American way is to scale things up, and industrialize them. I've seen the inside of a few mental health wards when friends of mine have been committed. They can still be pretty awful, and I don't want to see them scaled up. I don't think that is a problem that can be solved with bigger, more industrial, institutions. I look to Geel[1] as an aspirational model, but I'm not sure such a thing is compatible with American culture. To properly address mental health problems, we need a profound cultural shift. Bit of a chicken-and-egg problem, really.
[1] https://www.npr.org/sections/health-shots/2016/07/01/4840833...
Lobotomy was one of a series of radical and invasive physical therapies developed in Europe at this time that signaled a break with a psychiatric culture of therapeutic nihilism that had prevailed since the late nineteenth-century.[28] The new "heroic" physical therapies devised during this experimental era,[29] including malarial therapy for general paresis of the insane (1917),[30] deep sleep therapy (1920), insulin shock therapy (1933), cardiazol shock therapy (1934), and electroconvulsive therapy (1938)
Medicine is much trickier. If an eminent doctor declares a medical treatment to be successful and others doubt, can the controversy be settled by a randomized controlled trial? That requires that the control group be deprived of a treatment that has the approval of an eminent doctor. Tradition views that as unethical and forbidden.
The next big date is 1972 and the publication of Effectiveness and Efficiency: Random Reflections on Health Services. Archie Cochrane moved things along with straight talk about how few medical treatments actually worked. Trusting eminent doctors had been tried and failed. It was time for randomized controlled trials to be used, not just for proposed new treatments, but to review old treatments that some doubted.
But returning to 1907, one notes that Archie Cochrane was born in 1909. The man who persuaded the world that biostatistics was for medicine, not just plants, wasn't born yet.
Dismantling the state "asylum" system in the 1970's looks poorly timed in retrospect. The mentally ill end up missing out on the transition from eminence based medicine to evidence based medicine. Too late to go back and fix it; we've moved on to money based medicine :-(
Looks like we are back to that situation again. The promise of big Pharma that medication would magically make mental illness able to be treated completely in an outpatient manner has failed spectacularly. We shut down a lot of these mental asylums without providing a replacement.
Now it’s mostly the streets.
Big Pharma had nothing to do with the decision to get rid of mental hospitals. That was part of the generalized 70s breakdown of trust in authority and belief that community can do everything if you just believe hard enough. Care in the community never happened and if your entire strategy, insofar as you have one, relies on that, you just get deinstitutionalisation of the mentally ill. The same period saw quadrupling of crime rates. All part of the same phenomenon of social change.
The mental hospitals were horrific; unambiguous human rights violations were the norm and ubiquitous in them. The core of the deinstitutionalization movement was a legitimate reaction to that.
It's also true that rapid developments, and growing (over) confidence, in psychiatric medicines were a major part of presenting an alternative that people could generally accept.
And it fit well into the Reagony zeitgeist of the time, of removing large-scale institutions of social support. Deinstitutionalization was supposed to have two steps: first was to remove the large generalized asylums. The second was to be replacing them with smaller, community support-based, specialized institutions more aligned with the needs of the individuals.
Obviously the second never happened, and you can argue that it was never meaningfully intended to by the people with the power to do it. But it wasn't even mostly a "breakdown in trust" in general, and actually displays a level of trust in large-scale commitment to social efforts that we rarely see anymore.
It wasn't naiveté either, the institutions were genuinely horrific! They needed to be replaced with something, instead they were replaced with nothing. The fault is in the followthrough rather than the original impetus to deinstitutionalize.
Yes, if you don’t trust the social institutions because they’ve visibly failed you don’t support them. More or less everyone who was voting in the 80s would know that they were living in a society that was much higher crime than it had been. This is after huge expansions in social programmes.
To see the modern version of this calculus
> low density is a bet on institutional failure https://twitter.com/RogueWPA/status/1530298502382661634?s=20...
A comment on this tweet
> The reason people don't care about about "walkable cities" and the urbanism push in general is because basically every public space in America ends up becoming the territory of mentally unstable and drug addicted vagrants. People don't feel safe in them. Its a hard truth.
https://twitter.com/river_is_nice/status/1530182991766507520...
- https://en.wikipedia.org/wiki/Napa_State_Hospital
- https://cahighways.org/ROUTE221.html
- https://en.wikipedia.org/wiki/Mendocino_State_Hospital
- https://cahighways.org/ROUTE222.html
They were pretty (in)famous for their eugenics practices: https://www.sfgate.com/opinion/article/Eugenics-and-the-Nazi...
"In 1933 alone, at least 1,278 coercive sterilizations were performed, 700 on women. The state's two leading sterilization mills in 1933 were Sonoma State Home with 388 operations and Patton State Hospital with 363 operations. Other sterilization centers included Agnews, Mendocino, Napa, Norwalk, Stockton and Pacific Colony state hospitals."
And for their research with mind-altering substances: https://www.mendocino.edu/sites/default/files/docs/departmen...
"Massive doses of LSD were given to alcoholic patients as part of what was thought to be mind-control experiments. Involuntary sterilizations were administered in a campaign to eliminate “feeblemindedness,” poverty, “lunacy,” crime and other conditions considered to be social problems."