Asylums and the Question of Place: The Ghosts of Failed Health Initiatives

When an initiative fails, I like to think about what it got right, what it got wrong, and what parts can be modified and improved. Just because something did not work in a past iteration under a certain set of circumstances does not mean we should not retain aspects of it as we move forward. Take, for instance, asylums for the insane, as they were called in the mid-nineteenth century.

Abandoned psychiatric hospitals might spark thoughts of imposing buildings from a bygone era overflowing with suffering patients, but these associations could not be more inconsistent with the intended purpose of the buildings. For those unfamiliar, a psychiatrist, Dr. Thomas Story Kirkbride (1809-1883), was frustrated by the mistreatment of the insane, many of whom were tucked away in basements, jails, or private residences in the early-to-mid nineteenth century. Kirkbride, building on his belief that patients could be treated, wondered if they might show signs of improvement if treated humanely. In his 1854 book, On the Construction, Organization, and General Arrangements of Hospitals for the Insane, Kirkbride carefully described how beautifully ornate hospital buildings situated amid rolling hills might ameliorate patient suffering.[1] Kirkbride wanted patients to have the experience of being treated as human beings with room and space to move as they strolled the grounds or sat in sundrenched rooms engaged in meaningful activities.

American reformer and proponent of humane treatment of the mentally ill, Dorothea Lynde Dix (1802-1887), successfully petitioned New Jersey to open Trenton State Hospital in 1848.[2] Trenton State was the first of many asylum buildings erected across the country in the mid-to-late nineteenth century that embodied the visions of Dix and Kirkbride. Patients were not shackled, patients had their own spaces, and they were treated with at least some modicum of respect.

Sadly, Kirkbride asylums became overcrowded by the late nineteenth century, and stories of abuse, neglect, and squalid conditions abounded. Such tales frequently cast an inexorable taint over the buildings and their surroundings. As the oldest Kirkbrides deteriorated past the point of repair, states and the federal government began shutting them down in a reform effort called deinstitutionalization. The rationale was that psychiatric medication made it possible for previously institutionalized populations to live independently outside of the asylum.

Throughout the nineteenth and twentieth centuries, many large hospitals—psychiatric and general hospitals alike—were constructed to meet the needs of a growing nation. Like their Kirkbride predecessors, some of these hospitals were situated in park-like settings and neighborhoods rather than in city centers or near major thoroughfares. Providence Hospital, located in the Mount Airy neighborhood of Cincinnati, Ohio, is an example of one. Providence’s grounds were home to many tree-lined paths, gardens, a picturesque old mansion, and a small pond.

But even more recent hospitals like Providence, which housed a psychiatric ward, simply could not accommodate the latest medical technology and equipment without undergoing significant renovations that would impair the hospital’s capacity to execute daily operations. It was cheaper to build a new hospital than it was to remodel Providence, a comparatively young but outdated hospital.

In the case of Providence Hospital and some Kirkbride Asylums the buildings and grounds—especially the memories and stories associated with them—remained long after the patients, staff, and visitors left. To better understand why these abandoned structures and lands were not sought after for redevelopment, I pondered the following questions as I walked the grounds: What ideas and assumptions do people hold that makes the idea of living or working on the land where a former hospital once sat undesirable? Should the hospital campus become a museum, a park, a housing complex, another institution, or be reclaimed by nature? How long does it take for any of these transformations to occur? Do all abandoned hospitals face this problem, or is it unique to asylums and hospitals with unsavory histories?

Providence Hospital

Providence sat on more than 50 acres. The land formerly belonged to the Pinecroft Estate owned by Powel Crosley Jr. (1886-1961), a local inventor and radio broadcaster. When Crosley died, his daughter sold some of the land. The Franciscans bought it and opened Providence in 1971. It operated until 2013 when a more modern building, Mercy Health-West Hospital, opened a few miles away. Since it was shuttered, plans to convert the old hospital into government offices and a new county morgue were pitched. The price to renovate the old hospital structure, $30 million, caused those deals to fall through. In Providence’s case, it seemed nobody wanted to buy the structure because it was simply too expensive to renovate. It was demolished in 2015. Nobody protested its demolition because it was not a historically significant structure. With the land cleared, plans to build a subdivision were launched, but they fell through. For three years, a series of half-hearted development plans were introduced, but all failed. 

When I explored the grounds in 2018, only a few stray piles of furniture remained. The buildings and their contents were gone, but the hospital still felt very much like it was a part of the landscape, and it was no wonder that it did. For decades, the signs, many of which were still erect at the time of my visit, had instructed people on how to navigate the hospital campus, which consisted of a general hospital complex and a separate behavioral health unit. The treelined paths probably afforded employees a pleasant outdoor environment during breaks and gave visitors a silent space to reflect. As I stood there taking it all in, I half expected, as I followed the signs, to walk up to the main building, but it was not there where I expected it to be. Its absence was eerie and curious.

Photo taken by the author in 2018. [Image description: An asphalt road, partially milled on a foggy morning. A pile of old hospital furniture and a tree line can be seen in the background.]

As I continued to walk, I began to note a few differences between Providence and the old Kirkbride asylums I studied and knew so well. First, this hospital was a relatively young structure—only 52 years old when it was abandoned and 54 years old when it met its demise. By comparison, parts of Trenton State Hospital, the first Kirkbride, are still standing after turning 173 years old this year. Second, Providence was a general hospital with a psychiatric ward, not merely a mental health facility. Third, it occupied the grounds of Pinecroft, a slightly older (1928) and more unique historic structure, which was entirely preserved and restored. Finally, there were no real tales of abuse and neglect associated with the place. And yet, nobody wanted the buildings, so they were destroyed. Now nobody seemed to want the land, either.

Abandoned asylum and hospital buildings usually suffer one of these four fates: first, they are completely razed and only an empty field remains in their wake. This was Providence’s fate for a few years. Second, they are demolished, and subdivisions are built on the land. Danvers Asylum in Massachusetts, for instance, was mostly demolished and turned into housing, although the façade of the original Kirkbride building is preserved. Third, the buildings are salvaged, restored, and turned into hotels, other institutions, or museums. Buffalo State Asylum in New York is now Hotel Henry, the Trans-Allegheny Lunatic Asylum in West Virginia was restored and operates as a museum, and The Ridges in Athens, Ohio, was renovated as offices, gallery space, and storage for use by Ohio University. Or fourth, portions are preserved, but most of the asylum is cleared away. In the case of the Indianapolis Hospital, a portion was preserved and turned into a Medical Museum; the Northampton State Hospital in Massachusetts still boasts the original asylum fountain and the male attendants’ ward even though the Kirkbride building was torn down more than a decade ago.

Would Providence ultimately take one of these four paths as it reintegrated into a community that had changed considerably since the early 1970s? While these are fates that most derelict buildings might endure, asylums and hospitals raise unique questions about historic preservation and other issues because they tend to sit vacant for long periods, giving people time to think. Were people reluctant to build on land that was once the site of a structure where so many died over the years? Could it be that the spaces constantly occupied by sick people take on a certain stigma, a stigma of place? Perhaps, but Providence Hospital likely sat vacant because it simply seemed like a hospital. The site had housed a hospital for decades, and nobody bothered to reimagine the site as anything else. Ultimately, they did not need to reimagine the space.

The gates at Pinecroft. Photo by author (2021). [Image description: The main driveway to Pinecroft. The driveway is in the middle, flanked by two brick and stone columns. On the right column, there is stop sign and the pedestrian gate to the far right. On the left, there is an alcove for attendants. Trees are seen in the background.]

Modern “Asylums”

In October 2018, a few months after my first visit to the grounds, Acadia Healthcare proposed to build a $21 million 80-bed behavioral health unit on the old Providence Hospital site—about $9 million less than it would have cost to renovate the old building.[3] The new facility, which focuses on treating behavioral disorders, mental health disorders, mood disorders, and substance abuse and addictions, sits in the very spot where the old hospital sat. The current hospital is called Glenwood Behavioral Health. The adjacent mansion is now called Pinecroft at Crosley Estate and operates as a bridal and event venue. And Glenwood Behavioral Health is hardly the only brand-new behavioral health hospital in the country.

Recently, a New York Times article described the Taube Pavilion, a new behavioral health facility at the El Camino Hospital in Mountain View, California.[4] The Taube Pavilion, which houses the Scrivner Center for Mental Health & Addiction Services, was praised for its beautiful open architecture and calming mountain views. Each patient has their own room, and the hallways and common spaces were described as light and airy. Descriptions of the Taube Pavilion (light and airy, with innovative architecture and calming views intended to augment treatment) are reminiscent of the Kirkbride hospitals designed more than 150 years ago. Yet there was no mention of Kirkbride, Dix, or associated movements like moral treatment in the article on this new behavioral health facility.

The need for short and long-term care facilities did not disappear as proponents of deinstitutionalization imagined it would. In fact, a new urgent need, addiction, appeared and seems to be driving the demand for additional facilities that provide targeted treatments for those with behavioral health problems. Both Glenwood and the Taube Pavilion incorporate, perhaps unintentionally, some of the best features of past mental health initiatives including architectural designs intended to calm patients, short and long-term care offerings, and serene outdoor environments to relax those who may be struggling with addiction or mental illness.

Are facilities like Glenwood and the Taube Pavilion simply Kirkbride asylums and moral treatment warmed over, or are there innovative components that might contribute to their longer-term successes? Perhaps it is too early to tell, and maybe the path forward is unclear. In the meantime, many abandoned hospitals, like specters, are still standing to serve as formidable reminders that we have done much of this before, and hopefully this time we will achieve better results.

[1] Thomas Story Kirkbride, On the Construction, Organization and General Arrangements of Hospitals for the Insane (Philadelphia, PA: Lindsay & Blakiston, 1854).

[2] Dorothea Lynde Dix, Memorial Soliciting a State Hospital for the Insane: Submitted to the Legislature of Pennsylvania, February 3, 1845 (Harrisburg, PA: J.M.G. Lescure, printer to the State, 1845).

[3] Barrett J. Brunsman, “$21M hospital proposed for former Mercy Health site,” Local12 (October 26 2018).

[4] Jane Margolies, “A New Tool in Treating Mental Illness: Building Design,” The New York Times (January 5, 2021).

*Cover image: The grounds of the former Providence Hospital. Photo taken by author in 2018.

*Cover image description: Foggy footage of a green area flanked by a walking path and tall trees.

Edited by Diana M. Valencia, reviewed by Emily Webster.

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