Dr. Thomas Kirkbride | Indians, Insanity, and American History Blog

Isaac Ray, Asylum Superintendent

Once asylum superintendents gained a measure of respect and prestige (see last post), they used their power to secure their positions within both the medical community and their own specialty. They wanted no meddling or advice from outsiders–especially non-medical outsiders–and fought against any kind of oversight that involved community laypeople. Boards comprised of leading citizens often oversaw the running of asylums, but many times they acted as rubber stamps for whatever the superintendent decided was best. Superintendents could accept a few suggestions, of course, but they particularly resented laypeople making any kind of staff appointments. They did not want to see superintendent or assistant superintendent positions filled through committees of laypeople or appointed by the state governor. Instead, these specialized alienists wanted to establish and maintain a closed circle of “members” who controlled all aspects of asylum management.

This attitude marked their whole approach to management. Besides being very involved with the architectural details and physical construction of the asylum (superintendents were often appointed well before an asylum opened), superintendents imposed their own treatment philosophy on their institutions. “One man, one rule” defined their medical attitude–they wanted all decisions to go through them. They were usually quick to dismiss suggestions from patients’ families, even though these people undoubtedly had valuable insights to offer. This top-down, “I’m the expert” attitude was firmly entrenched by the time the Canton Asylum for Insane Indians opened, and its patients were in a particularly poor position to have their voices accepted.

Asylum Plans

Kirkbride's Plan was Used for Many Asylums

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The Hudson River State Hospital Was a Kirkbride Building

Interest in mental health and how to care for the mentally ill heightened as time went on and professionals became more immersed in studying the intricacies of the mind and human behavior. In the United States, by the turn of the twentieth century large asylums were still the tool of choice for helping the insane become well, or for dealing efficiently with the chronic insane. As mental health specialists made advances in treatment, they continued to look at ways to present themselves and their work to the public in a positive way.

In 1854, the Association of Medical Superintendents of American Asylums for the Insane (AMSAAI) debated on what terms they should use to even describe the buildings where their patients lived. Dr. Thomas Kirkbride, a pioneer in asylum architecture, presented a paper at the AMSAAI’s ninth meeting: “On the Importance of Precision and Accuracy in the Use of Terms for Insanity and Instructions for its Treatment.” In it, he objected to worlds like lunatic, asylum, retreat, keeper, and cell to describe anything within the walls of what were commonly known as insane asylums. In many people’s minds, the word “hospital” was only a place for paupers and outcasts, so it was not suitable, either. “Insanery” seemed suitable to one doctor discussing the paper, since it resembled the British word “infirmary.” This particular alienist (mental health specialist) did not especially object to the terms asylum or lunatic, since the former signified a sacred place or sanctuary, and the latter had been in common usage for a long period.

By 1920, at the seventy-sixth annual meeting of the American Medico-Psychological Association, which had incorporated the old AMSAAI, words like cell and keeper had indeed been discontinued because of their negative connotations. Now the concern at hand was whether or not to change the name of their organization and the way they referred to insanity. In the end, the organization was re-named the American Association of Psychiatrists, and the word psychiatry was substituted for the words “the treatment of insanity.”

Dr. Thomas Kirkbride and His Book on Building Asylums

Philadelphia Hospital for the Insane, circa 1900, courtesy University of Pennsylvania

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Indians, Insanity, and American History Blog

Asylums And Insanity Treatments 1800 – 1935

Tag Archives: Dr. Thomas Kirkbride

Medical Attitudes

Putting a Name on It