Elaborately conceived, grandly constructed insane asylums—ranging in appearance from classical temples to Gothic castles—were once a common sight looming on the outskirts of American towns and cities. Many of these buildings were razed long ago, and those that remain stand as grim reminders of an often cruel system. For much of the nineteenth century, however, these asylums epitomized the widely held belief among doctors and social reformers that insanity was a curable disease and that environment—architecture in particular—was the most effective means of treatment.

In The Architecture of Madness, Carla Yanni tells a compelling story of therapeutic design, from America’s earliest purpose—built institutions for the insane to the asylum construction frenzy in the second half of the century. At the center of Yanni’s inquiry is Dr. Thomas Kirkbride, a Pennsylvania-born Quaker, who in the 1840s devised a novel way to house the mentally diseased that emphasized segregation by severity of illness, ease of treatment and surveillance, and ventilation. After the Civil War, American architects designed Kirkbride-plan hospitals across the country.

Before the end of the century, interest in the Kirkbride plan had begun to decline. Many of the asylums had deteriorated into human warehouses, strengthening arguments against the monolithic structures advocated by Kirkbride. At the same time, the medical profession began embracing a more neurological approach to mental disease that considered architecture as largely irrelevant to its treatment.

Generously illustrated, The Architecture of Madness is a fresh and original look at the American medical establishment’s century-long preoccupation with therapeutic architecture as a way to cure social ills.

Carla Yanni is associate professor of art history at Rutgers University and the author of Nature’s Museums: Victorian Science and the Architecture of Display.

In the history of medicine, hospitals are usually seen as passive reflections of advances in medical knowledge and technology. In Medicine by Design, Annmarie Adams challenges these assumptions, examining how hospital design influenced the development of twentieth-century medicine and demonstrating the importance of these specialized buildings in the history of architecture.

At the center of this work is Montreal’s landmark Royal Victoria Hospital, built in 1893. Drawing on a wide range of visual and textual sources, Adams uses the “Royal Vic”—along with other hospitals built or modified over the next fifty years—to explore critical issues in architecture and medicine: the role of gender and class in both fields, the transformation of patients into consumers, the introduction of new medical concepts and technologies, and the use of domestic architecture and regionally inspired imagery to soften the jarring impact of high-tech medicine.

Identifying the roles played by architects in medical history and those played by patients, doctors, nurses, and other medical professionals in the design of hospitals, Adams also links architectural spaces to everyday hospital activities, from meal preparation to the ways in which patients entered the hospital and awaited treatment.

Methodologically and conceptually innovative, Medicine by Design makes a significant contribution to the histories of both architectural and medical practices in the twentieth century. 

Annmarie Adams is William C. Macdonald Professor of Architecture at McGill University and the author of Architecture in the Family Way: Doctors, Houses, and Women, 1870–1900 and coauthor of Designing Women: Gender and the Architectural Profession.