thumb|An 1848 lithograph of the Kirkbride design of [[Trenton Psychiatric Hospital|Trenton State Hospital in Trenton, New Jersey]]
thumb|The [[Traverse City State Hospital in Michigan, in operation from 1881 to 1989, is an example of a Kirkbride building]]
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.
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, but had in common the "bat wing" style floor plan, housing numerous wings that sprawl outward from the center.
The first hospital designed under the Kirkbride Plan was the Trenton State Hospital in Trenton, New Jersey by John Notman, constructed in 1848. 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
Basis and philosophy
thumb|[[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.
Thomas Story Kirkbride (1809–1883), a psychiatrist from Philadelphia, Pennsylvania, developed his requirements of asylum design based on a philosophy of Moral Treatment and environmental determinism. 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." The idea of institutionalization was thus central to Kirkbride's plan for effectively treating the insane.
Design and architectural features
thumb|The floor plan for the Kirkbride design from an 1854 lithograph
The Kirkbride Plan asylums tended to be large, imposing institutional buildings, 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. The standard number of wings for a Kirkbride Plan hospital was eight, with an accommodation of 250 patients. 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.
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. The wings furthest from the center complex of the building were reserved for the "most excitable," or most physically dangerous and volatile patients.
Patient rooms were suggested to be spacious, with ceilings "at least high," but only large enough to room a single person. 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. Architectural styles of Kirkbride Plan buildings varied depending on the appointed architect, and ranged from Richardsonian Romanesque to Neo-Gothic.
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." Kirkbride also suggested the hospital grounds be a minimum of in size. The foliage and farmlands on the hospital grounds were sometimes maintained by patients as part of physical exercise and/or therapy. Over the course of the nineteenth and twentieth centuries, the campuses of these hospitals often evolved into sprawling, expansive grounds with numerous buildings.
Operations and staffing
{|class="wikitable floatright"
|+ Salaries per annum (1854)
|-
! Position !! Compensation <small>(USD)</small>
|-
| 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
|-
|}
thumb|A child, ostensibly of the physician-in-chief, swinging on the lawn of the [[Oregon State Hospital, ]]
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. The superintending physician, or physician-in-chief, was required to live in the main hospital or in a building contiguous to it, while his family had the option of residing at the hospital or seeking private lodging. The staff was also to have a balanced sex distribution, with approximately 36 female and 35 male staff members.
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. 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: "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.
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."
Salary for the superintending physician according to the 1854 guideline was to be USD$1,500 () if the physician's family resided at the hospital, and $2,500 () if they found lodging at a private residence. 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.
Decline and phasing out
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. General psychiatric and medical opinion of Kirkbride's theories regarding the "curability" of mental illness were also questioned by the medical community.