Madness, Architecture and the Built Environment

Psychiatric Spaces in Historical Context

James Moran, Leslie Topp, Jonathan Andrews

• Publisher: Routledge
• Year: 2020
• ISBN:
  9781135653156
• Edition: 1
• Topic: Architecture
• Subtopic: Architecture General

This is the first volume of papers devoted to an examination of the relationship between mental health/illness and the construction and experience of space. This historical analysis with contributions from leading experts will enlighten and intrigue in equal measure. The first rigorous scholarly analysis of its kind in book form, it will be of particular interest to the history, psychiatry and architecture communities.

1 Introduction

Interpreting psychiatric spaces

James Moran and Leslie Topp

Spatial separation has been one of the most frequent social responses to madness. From the early modern period to the present, designing and creating alternative spaces, whether conceived as curative, healing, managerial, or custodial, has dominated the western response to those considered mentally troubled. This volume is dedicated to exploring these spaces. It explores the ways in which they emerged, the different shapes they could take in various historical and geographical contexts, the debates they incited, the ways that they were exploited and undermined by various parties, and how those spaces related to the worlds beyond their borders. It brings to the field a close examination of psychiatric spaces as spaces, buildings for the mad as buildings, using the tools of geographers, art historians, and architectural historians as well as those of medical historians and sociologists.

In many respects, the spatial and architectural contexts of psychiatry and mental illness are related to those of medicine more generally. Built spaces have been important formative factors in changing modes of care for the physically ill, and in evolving forms of clinical research for the medical profession. The study of these spaces also reveals a great deal about their originators’ desire to communicate their self-image to various publics.¹ All these things are true as well for ‘psychiatric spaces’. But because of the key importance of spatial separation to the history of psychiatry, space and architecture have arguably been emphasised even more by psychiatrists, architects, reformers, and others, than they have by those dedicated to the wider field of medicine. That centrality has not, however, meant greater understanding—the asylum, for instance, much more than the general hospital, has been subject to polemical battles that have not only obscured the complexity of asylums themselves, but also overshadowed the many other types of built spaces in which madness has existed.

This is the first volume of collected essays on the history of madness, psychiatry, and the built environment. Collectively, the essays reconsider the importance of psychiatric spaces within the wider history of mental illness. In so doing, this volume challenges and nuances the existing historiography which, with a few important exceptions, has not done justice to the history of psychiatric spaces.² In fact, we would argue that there has been a strategic over-simplification at work in the historical accounts of the spaces ‘reserved for madness’.³ This tendency reaches back to eighteenth-century Britain and France, and the impulse to rationalize and reform the management of the mad through the first plans for public asylum provision. With each wave of reform from the late eighteenth century onwards, a modified version of psychiatric space was embraced as the final answer, while the history of previous spatial solutions to insanity was rewritten, caricaturing these solutions as crude, irrational, and unsuccessful.⁴ Later, defenders of the asylum writing in the first half of the twentieth century often took at face value the caricatures made by asylum superintendents of a pre-asylum era of brutality towards the insane.⁵ In hindsight, it is also clear that earlier revisionist historians combined over-determined critiques of a self-serving psychiatric profession with descriptions of asylums as buildings that first and foremost served the needs of capital.⁶ Both Whig and revisionist perspectives loaded more ideological weight onto asylums than they could bear, at the same time that they generated forceful and compelling debates that channelled research and writing away from alternative avenues of historical inquiry.⁷ Finally, since the 1960s, the policy embraced in large parts of the western world of closing large public asylums and replacing them with ‘care in the community’, has reinforced the public perception of separate, contained spaces for mental illness as undifferentiated black holes for society’s unwanted.⁸

It is not the goal of this volume to resuscitate the reputation of the asylum system or to advocate any particular approach to psychiatric space. Rather we seek to contribute to an understanding of these buildings and spaces as complex social, cultural, and medical phenomena. In some respects this is not a new goal, and this volume needs to be seen as part of the existing and ongoing project of rewriting the history of mental disorder. The chapters that follow form a part of recent trends in the field that have moved well beyond earlier custodial/curative debates which tended to confine academics within the geographical and conceptual boundaries of the asylum.⁹ But unlike such ground-breaking projects as the three volume series edited by Bynum, Porter, and Shepherd, which inaugurated the new madness history with a deliberately wide-ranging approach,¹⁰ this edited volume is self-consciously bounded by the central theme of psychiatric/mad space—institutional, intra-institutional, non-institutional—including a consideration of the full range of actors complicit in the social construction of that space. In this respect, this volume resembles more the thematically focused contribution of Roy Porter and David Wright which examines asylum patients in international perspective.¹¹

No re-evaluation of the history of madness, architecture, and the built environment, could ignore the importance of Michel Foucault’s legacy to the history of psychiatry, even if his work is now seen by many in the field as historically suspect, or as inaugurating polemical battles that we are now trying to transcend.¹² For, as Chris Philo has argued, one of Foucault’s most vital contributions to a history of psychiatry that had, until his intervention, been characterized by ‘a-spatial’ grand narratives of progress, was an engagement with the spatial aspects of the topic. This contribution was all the more important since, as Philo puts it, ‘”spatial relations” have been central to the very functioning of past mad-businesses.’¹³ Furthermore, Foucault points towards an interdisciplinary approach to space of the type we are aiming for here. That is, his spatial approach is historical and sociological, while at the same time being open to the symbolic and metaphorical meanings of spatial entities which can be seen as the province of the history of art and architecture.¹⁴ By marshalling this interdisciplinary approach into an analysis and, some would argue, a complex theory of madness and power, Foucault was able to break the presentist cycle described above, in which each new development left previous ways of spatially defining and responding to the insane seeming crude and confused. In his Histoire de la folie, Foucault was able to show how various ways of spatially separating the mad (medieval imprisonment, classical confinement, the late eighteenth-century reform asylum under Tuke and under Pinel, the nineteenth-century positivist asylum) were each in their own right both complex and coherent, even as he made historical claims for these categories that historians have since rejected.¹⁵ Later, in his study of the history of modern incarceration (which focused on the criminal justice system but which was intended to be relevant as well to the confinement of the mad), Foucault also provided a model of interdisciplinary analysis, combining the study of the history of penal reform with analyses of urban spectacle and architectural systems of controlling bodies.¹⁶

For historical geographers and architectural historians the idea that architecture and constructed spaces (which are not necessarily the same things) are formative forces within the history of psychiatry (as opposed to reflections or illustrations of deeper historical tendencies) is not new or exceptional. Thomas Markus’s analysis of the role of freedom and control in the development of modern building types focuses on the late eighteenth century, and sees asylum buildings, along with schools, prisons and workhouses, as part of a concerted effort to put purpose-built buildings at the centre of the project of forming and reforming character. For Markus, a close analysis of the plans and use of asylum buildings can lead to new observations about what early psychiatry, in a social historical context, aimed to achieve.¹⁷ Similar arguments have been put forth about the asylum as part of an ‘institutional archipelago’ of reform by David Rothman for the United States, Michael Katz, Michael Doucet, and Mark Stern for North America, and by Andrew Scull and David Garland for Britain.¹⁸ Christine Stevenson’s study of British hospital and asylum architecture in the ‘long’ eighteenth century stressed the often ambiguous ways in which buildings themselves, the process of planning buildings, and visual and textual representations of buildings, structured the public presentation and understanding of provision for the insane. The ambivalence surrounding the whole idea of institutional care for the mad, and the changes in what was understood by the notion of the asylum are both reflected and constructed, in Stevenson’s account, by asylum architecture.¹⁹ In a different context, Carla Yanni has traced the rich debates in nineteenth-century America about how the architecture of asylums could best cure insanity.²⁰ This volume contains several contributions that further assess how built environments have affected past psychiatric perceptions and practices.

It is worth saying something at this point about our use of terms. The title of the volume distinguishes between ‘architecture’ and the ‘built environment’, and the subtitle refers to ‘psychiatric spaces’. By not restricting ourselves to ‘architecture’, we are indicating that the scope of the volume extends beyond purpose-designed buildings for the insane (though these play a large role) to other spatial settings, built and ‘natural’, rural and urban. We are also signalling our interest in approaches (by users, non-architect planners and the public) to spatial arrangement and the built environment that are not usually encompassed in the term architecture (for example, the subsequent, post-planning history of an asylum building; users’ memories and associations with certain wards of a hospital; and psychiatrists’ views on appropriate lighting and the locations of toilets).

On the other hand, we want ‘architecture’ to indicate more than the buildings themselves—it encompasses, for example, unbuilt projects, competitions, manuals, professional rivalries, and images used for publicity. Finally, we use the word madness in the broadest sense of the term—it is a word that is not only historically appropriate in terms of the extent and scope of its use by a wide spectrum of society from the early modern period onwards, but it also encompasses in its definition an equally broad spectrum of behavioural meanings.

By combining the more complicated picture emerging from new scholarship in the history of psychiatry with the perspective that the role of constructed space is not incidental, we aim to shed new light on a number of questions. Rather than using the rest of this introduction to summarise the content of each chapter, we will point to what we see as the main concerns emerging from the volume as a whole. These include: the role built space played in narratives of psychiatric progress; the spatial formations of non-institutional responses to madness; the intersection of the domestic and the institutional; the situating of psychiatric institutions and the way they related spatially to the world beyond their borders; the way spaces and architecture were manipulated both to classify patients and to create visual impact; the complex interaction between space and surveillance; and visual and spatial features imported into psychiatric spaces from outside psychiatry.

We referred above to the ways in which the spatial articulation of the asylum was tied up, from the age of the ‘reformers’ on, with narratives of psychiatric progress. Each new wave of thinking about what would constitute effective, healing provision for the insane presented a new vision of the way the asylum building would be laid out, used, monitored and viewed from the outside. Psychiatrists’ investment in particular visions of the spatial operation of the asylum could be strong enough to blind them to aspects of the reality of the day-to-day life in the asylum that contradicted that vision. Kai Sammet shows the extent to which German advocates of Roller’s well-ordered asylum were committed to the possibility of a space in which not only the patients but also the attendants were constantly observed. These asylum advocates executed scientific somersaults in the attempt to prove that patients who showed the signs of having been physically beaten (in moments when the well-ordered asylum broke down) were in fact suffering from an obscure brain condition peculiar to the mentally ill. Though psychiatrists tended to see the asylum type they advocated or embraced as existing outside of time, and isolated from the concrete cultural and political realities of the world beyond its walls, a ‘purely medical’ environment was an impossibility. Sally Swartz offers a stark example of the implication of asylum planning ‘progress’ in the political assumptions of a time and place; in South Africa around 1900, the more ‘scientific’ the asylum was the more anxious its designers’ were to classify and segregate on the basis of skin colour as well as psychiatric disorder. The history of psychiatric institutions is also one of buildings outliving the specific set of assumptions and circumstances that originally gave rise to them. Chris Philo’s study of the shifts in uses of and users’ associations with the Craig Dunain psychiatric hospital examines an example of this phenomenon.

These narratives of psychiatric progress, constructed rhetorically in the annual reports of first generation alienists, and more concretely by architects and other asylum builders, were designed in part to alter the long held views of those who relied on local and domestic spaces for the management and treatment of the insane.²¹ Research by Rab Houston, Chris Philo, Akihito Suzuki, and James Moran on those domestic and local spaces of confinement against which psychiatrists were writing has uncovered a plethora of largely non-professional and non-institutional customary practices surrounding the insane that were often specific to the local contexts in which they developed.²² What is emerging from these investigations is the ‘unasy...

Table of contents

• Cover
• Half Title
• Series Title
• Title
• Copyright
• Contents
• Preface
• 1 Introduction: Interpreting psychiatric spaces
• PART I Madhouses, asylums, and hospitals in context
• PART II Case studies in psychiatric space
• PART III Beyond the institution
• PART IV Race and space in colonial asylums
• PART V Architects and institutions
• PART VI Spatial players: Professionals and patients
• Contributors
• Index