The Architecture of Madness: An analysis of English Psychiatric Institutions since the Eighteenth Century PDF

Preview

Summary

! ! ! ! ! ! [DISSERTATION IN ARCHITECTURAL STUDIES] !! !! !! ! ‘The Architecture of Madness: An analysis of English Psychiatric Institutions since the Eighteenth Century’ ! ! ! ! ! ! ! ! Candidate Name: Francesca Denny Candidate Number: 21008234 Course: Architectural Studies Module: Dissertation in ...

Description

! ! ! ! ! !

[DISSERTATION IN ARCHITECTURAL STUDIES] !! !! !! !

‘The Architecture of Madness: An analysis of English Psychiatric Institutions since the Eighteenth Century’

! ! ! ! ! !

! !

Candidate Name: Francesca Denny Candidate Number: 21008234 Course: Architectural Studies Module: Dissertation in Architectural Studies Assessment: Essay Session: Semester II Supervisor: Dr Sue North-Bates!

! ! ! ! ! ! ! ! ! ! ! !

“I wonder if rooms in an insane asylum have Do Not Disturb signs for the doors. I should hope not, because knock or no knock, every occupant in those rooms is already disturbed.”

!

Jarod Kintz, 2011.The Days of Yay are Here! Wake Me Up When They're Over.

! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! !

Acknowledgements

!

I would never have been able to finish my dissertation without the support and encouragement from a great number of individuals over the past year.

!

I would like to express my deepest gratitude to my supervisor, Dr Sue North-Bates, for her excellent guidance, patience and for providing me with a wealth of contextual socio-cultural knowledge within the realm of Architectural History and whose expertise has proven invaluable throughout the entirety of this thesis.

!

I would like to thank Dr Chris Rust, who so willingly accommodated my queries, despite his retirement. Paul Yeomans and Lianne Knotts, RIBA, associate directors and senior architects at Medical Architecture, whose swift responses and astounding expertise in the design for Mental Health has greatly influenced my work. Caroline and Clarence Vaz, who have allowed me to exercise my passion for both architecture and psychiatric care at Parklands Nursing Home. My empirical knowledge of the mental health environment would have never have been possible without my job as a HCA.

!

Western Bank Library, whose stunning architecture, abundance of texts (and lenience with library loans) provided me with a strong foundation for my research and a place of repose throughout the writing process of this dissertation.

!

My parents, who never tired of relentless late night tears and phone calls, and whose encouragement and support acted as a driving force throughout the year. Special thanks to my friends, who have tolerated countless hours listening to me talk about my research. I know it’s hard to share my passion for asylum architecture, but thank you for lending me your ears and for quelling my stresses and worry.

!

Finally, thanks to Paul Buckley, who, without his belief, would have never have led me down the path of architecture and design, and for which I’m truly grateful.!

! ! ! ! ! ! !

!

Contents

! Acknowledgements Introduction……………………………………………………………..……………………………………iii List of Illustrations…………………………………………………………..…………………………….….vi List of Tables…………………………………………………………………………………………………vii

Part I: The Early Asylum: the design for healthcare in Eighteenth and Nineteenth Century England

Bedlam: A Contextual History on the role of the Asylum in England…………..…..….…..….2

How did the York Retreat influence subsequent architectural design in the realm of psychiatric care?…………………………………………………………………………………………..…9 Jeremy Bentham and the Panopticon: how did the philosophical ideal shape asylum architecture?……………………………………………………………………………………12 What did the introduction of the County Asylums Act in 1808 and Lunacy Act of 1845 mean for the design of asylum architecture?…………..………………………………….…….……16

! Part II: The Age of the Asylum: 1845-1983 The architects who shaped the way for Twentieth Century institutions………………..…….24 Death, treatment and the social deviant in the Victorian Asylum….…………..……..….…..30 The Demise of the Asylum: Mass Closure of Mental Institutions……………..……………34 The Care in the Community Movement………………………………………..……..…….39

! ! ! !i

! Part III: The Psychiatric Hospital in its modern context Interpreting space and place through the experiences of patients in mental health care facilities……………………………………………………………………….…………….43 The benefits of using architectural psychology in designing facilities for patients with dementia……………………………………………………………………………………47 The Use of Green space in the design for Mental Health…………………………………50 Towards a new Architectural Pedagogy…………..………….…………………………….56

! Conclusion…………………………………………………………………………………..………………60 Appendix I: The Kirkbride Plan………………………………………..………………………………..…62 Appendix III: Reasons for admission 1864 to 1889…………………..………………………………….…64 Appendix II: Briefing for Riverside Ward……………………………………………………………..……66 Appendix IV: Design and Planning for Mental Health…………………………………………………….68 Bibliography…………………………………………………………………………………………..…….69 Journal Articles………………………………………………………………………………….………….75 Websites……………………………………………………………………………………….…….….….78 List of Visual References………………….……………………………………………….……………….81 Further Reading………………………………………………………………………………..………….83    

! ! !ii

Introduction The perception of psychiatric illnesses and the need for better institutions has been prevalent since the dawn of the "asylum era", dating back to the 18th Century. Prior to this, treatment of the incarcerated was a barbaric and unjust exercise in human welfare. Facilities provided were often unsanitary, with dozens of people sharing dormitories; many sharing beds with up to four others, or held captive to the floor with shackles (Browne, 18371). Although the days where the common misconception was that 'a lunatic can be cured only in an institution' (Sine, 20082) have generally passed over its six hundred year history, it is still widely considered that facilities offered by psychiatric hospitals and centres are a contributing factor in the treatment of patients with mental disorders (Yanni, 20073). From the early 'lunatic asylums' of Bethlem Hospital, to the 19th century investments in construction of healthcare buildings in England, addressing the need for psychiatric facilities has been a daunting task for both clinical practitioners and architects alike. Since the advent of the NHS in 1948, there have been calls for reform in public institutions; however, it wasn't until the late 1950s that a call for a new architecture was implemented by the World Health Organisation- WHO (Baker, 19594). In order to provide the reader with insight into the role of the asylum within the Western World, a brief history explaining its cultural context will cover the conditions provided for mentally ill patients before the Eighteenth-century, and the subsequent medical advances which have influenced and further informed the need for a ‘new architecture’. The introduction into moral treatment throughout the period of the Enlightenment will explain how the impact of the Quakers directed the way for psychiatric medicine, the requirement for the humane treatment of its patients and how this influenced subsequent architectural design. An analysis into how the effectiveness of the Tuke’s York Retreat, a Quaker family whose focus lay in inducing rationality and moral strength within the patient community, will be evaluated and how this gave guidance to subsequent moral designs in psychiatric institutions.

1

BROWNE, William A. F., (1937) ' Lecture III: What Asylums Were' in: What Asylums Were, Are and Ought to be: Being the substance of Five Lectures delivered before the managers of the Montrose Royal Lunatic Asylum. Charles Black, Edinburgh. 98-133. 2

SINE, David M. (2008). The Architecture of Madness and the Good of Paternalism. Psychiatric Services. 59 (9), 1060-1062. 3

YANNI, Carla. (2007). The Architecture of Madness: Insane Asylums in the United States. Minnesota: University of Minnesota Press. 1-256. 4

BAKER, A. A. (1959). 'Psychiatric Services and Architecture' Public Health Papers Series I. World Geneva, Health Organization.

!iii

Evidence shows that environmental conditions influence human emotion and state of mind (Lippincott, Kuc & Hanson, 20095), especially in patients with dementia, or those who struggle to interpret their surroundings. The importance of design features, including vista, (Ulrich, 19846), colour, (Dalke, Littlefair & Loe, 20047), sound, (Lippincott, Kuc & Hanson, 20098), and arrangement of furniture, (Baldwin 19859), in a building have been linked with quicker recoveries of those with mental health issues. An analysis of architectural psychology and how architects strive to create a clear environment for the psychiatric patient will be assessed and evaluated on its effectiveness. Using modern technologies discreetly assists in patient security offers those with mental health issues greater freedom of movement when compared to the barred windows and locked doors that were once considered common practice. Additionally, this dissertation will provide a summary of findings through secondary sources given by architects involved with the construction of new psychiatric dwellings, and will discuss the psychiatric benefits of these environments for both clinical psychiatrists and patients. It is the intention of this thesis to validate the research of the design for healthcare, and its effectiveness in patient recovery. Similarly, the influence of horticulture on patient recovery is frequently documented, thus the incorporation of green space within the realm of the hospital has been an important addition to creating an appealing environment for the patient to heal and find repose. First considered over a thousand years ago, the use of green space has recently made a reprising role in the realm of health and wellbeing after taking a decline with in hospital environment in the early 1900s. Several studies have shown that simply looking at greenery, flowers or water in comparison with structural scenery absent from nature is significantly more effective in promoting restoration from stress (Ulrich, 200210). Merely looking out of the window is proven to have psychological benefits and is hypothesised to quicken recovery time (Ulrich, 198411). Many mental health

5

LIPPINCOTT Richard C., KUC Eugene J., Hanson Todd (2009). ‘Chapter 34: Design and Architecture’. In: SHARFSTEIN Steven S., DICKERSON Faith B., OLDHAM John M. Textbook of Hospital Psychiatry. American Psychiatric Pub, pp453-64. 6

ULRICH, Roger S . (1984). View through a window may influence recovery from surgery. Science. 224 (4647), 420-421. 7

DALKE Hilary, LITTLEFAIR Paul J., LOE David L. (2004). Lighting and Colour for Hospital Design. London: The Stationary Office . 1-91. 8

LIPPINCOTT Richard C., KUC Eugene J., Hanson Todd (2009). ‘Chapter 34: Design and Architecture’. In: SHARFSTEIN Steven S., DICKERSON Faith B., OLDHAM John M. Textbook of Hospital Psychiatry. American Psychiatric Pub, pp453-64. 9

BALDWIN, S. (1985). Effects of furniture rearrangement on the atmosphere of wards in a maximum-security hospital.. Hospital & Community Psychiatry. 36 (5), 525-8. 10

ULRICH, Roger S (2002). Health Benefits of Gardens in Hospitals. Texas : Texas A & M University. 1-10.

11

ULRICH, Roger S . (1984). View through a window may influence recovery from surgery. Science. 224 (4647), 420-421 .

iv !

services, including St Andrew’s Healthcare, Northampton, have introduced the cultivation and tending of green space into patient activity as a form of occupational therapy (Parkinson, Lowe & Vecsey, 201112). A plethora of physical benefits from this have been documented, including lowering blood pressure, heart activity and muscle tension (Ulrich, 199913). The affinity between humanity and nature offers patients the chance to reflect spiritually upon their health and rekindle the vernacular ideal of being in happy cooperation with nature and creating a unique essence within the healthcare environment. Through analysis of existing scholarship on asylum design theory from the eighteenth-century to the present day, and the creation of a therapeutic environment through the manipulation of space and its location, this thesis aspires to discuss the importance and need to develop a safe and healing environment in the creation of architecture for the mentally ill.  

! ! ! ! ! ! ! ! ! ! ! 12

PARKINSON Sue, LOWE Claire, VESCEY Therese. (2011). Therapeutic benefits of horticulture in a mental health service. British Journal of Occupational Therapy. 74 (11), 525-534. 13

ULRICH, Roger. S. (1999). Effects of Gardens on Health Outcomes: Theory and Research. In Cooper Marcus, C. and Barnes, M. (Eds). Healing Gardens’ Therapeutic Benefits and Design Recommendations. New York: Wiley.

v!

List of Illustrations I. Original site of Bedlam, Daniel Hick (1852) ………………………………………………………..…….4 II. Seventeenth-century map depicting new Bethlem …………………………………………………..……5 III. Melancholy & Raving Madness, Edward Walford ………………………………..………………..…..…6 IV. Hospitum Mente-Captorium Londiense, Robert Hooke (1676) ……………………………………………..….7 V. Original etchings of the plan and elevation of Jeremy Bentham’s ‘Panopticon’…………………………14 VI. Original etchings of Maison de Force, Ghent ……………………………………..……..…….…………….14 VII. Etching of James Lewis’ Bethlem, Riley (1830) ……………………..……………….……..……….….19 VIII. Plan & elevation of James Lewis’ Bethlem …………………………..……..……………………….…20 IX. Sydney Smirke’s resolved plan …………………..……………………………………………………….21 X. Smirke’s addition of the chapel dome & portico ……………………………………………………..….22 XI. Radial pavilion plan at St Luke’s, Middlesborough……………………………………………..…….…28 XII. Long Grove Hospital Asylum ……………………………………………..………………………….…37 XIII. The contrast between new and old façades in Northampton’s hospital architecture…………………..45 XIV. Visibility from residents’ bedroom windows, Francesca Denny (2014)…………………………………53 XV. Patient view from bedside, Francesca Denny (2014)…..…………………..……………………………..53 XVI. Landscaped garden at Parklands Nursing Home, Woolstone, Francesca Denny (2014)……….…..…..55 XVII. Limited view patients can enjoy from living room, Francesca Denny (2014)…………………………55 XVIII.Limited view patients can enjoy from living room, Francesca Denny (2014)…………………………55 XIX. Landscaped foreground at Parklands Nursing Home, Woolstone, Francesca Denny (2014)………..…56 XX. Victorian Nightingale ward…………………………………………………………………………..…58 XXI. Conceptual communal space …………………………………………………………………………..59

!vi

List of Tables I. Total Patients in Public Asylums in England and Wales 1850-1950 and Rate/ 10,000 people………….34 II. Resident Population of Mental Hospitals in England and Wales, 1951-1960 …………………..……….36 III. Resident Population of Mental Hospitals in England and Wales, 1960-1970……………………..…….36

! ! ! ! ! ! ! !

!vii

! ! ! ! ! ! ! ! ! ! ! ! Part I: The Early Asylum: the design for healthcare in Eighteenth and Nineteenth Century England

! ! ! ! ! ! ! ! !

Bedlam: A Contextual History on the role of the Asylum in England The term Asylum, meaning ‘place of refuge’, has always seemed like an oxymoron upon reading tales of the barbaric treatment of patients confined to unsanitary and inhumane cells. As an institution where those with mental illnesses could receive proper treatment in a safe haven, it is incomprehensible that human morality and conscience permitted physical restraints, acts of violence and lack of dignity as a manner of controlling the psychiatric needs of the most vulnerable of citizens. The first of these establishments in Europe was the religious priory of St. Mary of Bethlem, London, whose origins trace back to 1247 (Andrews, Briggs, Porter, Tucker & Waddington, 199714). It is thought that the priory was used as a place of asylum from its conception. Originally intended for the poor, the haven served those suffering from ailments to seek healing in the event that they had no other place of lodging or shelter (Roberts, 198115). The name Bethlem serves as a contraction of the Hebrew ‘Bethlehem’, meaning house of bread. From the fourteenth century, Bethlem has been colloquially referred to by a series of monikers, including “Bedleheem”, “Bedleem”, and, most famously, “Bedlam” (Andrews, Briggs, Porter, Tucker & Waddington, 199716). The site became a recognised hospital in 1330, the first of its kind within Europe, before being confiscated in 1375 by King Edward III and used as a gaol for prisoners from 1377 (Jones, 197217) and sat on the south site of what is now Liverpool Street Station (Allderidge, 197918). The first recorded number of the incarcerated shows there were as little as nine patients; of which, three were sane (Scull, 197919). Once reclaimed, the hospital admitted its first mentally ill patients between 1403-1407, although this is disputed. Whilst Spain earned the nickname of ‘the cradle of humane psychiatry’, due to their moral approaches in treating the convalescent, the English system could not have been seen as anything but the antithesis. The Spanish method of removing patient harnesses and chains in favour of a more occupational approach; focusing on diet, hygiene and activity is said to have been

14ANDREWS

Jonathan, BRIGGS Asa, PORTER Roy; TUCKER Penny, WADDINGTON Keir (1997). The History of Bethlem. London & New York: Routledge. 15

ROBERTS, Andrew (1981) Mental Health History Timeline. Available: http://studymore.org.uk/mhhtim.htm. Last accessed 26 Mar 2014. 16

ANDREWS Jonathan, BRIGGS Asa, PORTER Roy; TUCKER Penny, WADDINGTON Keir (1997). The History of Bethlem. London & New York: Routledge. 17

JONES, Kathleen. (1972) A History of Mental Health Services. London, Routledge & Kegan Paul.

18

ALLDERIDGE, Patricia. (1979) ‘Management and Mismanagement at Bedlam, 1547-1633. In: Webster, Charles. Health, Medicine and Mortality in the Sixteenth Century. Cambridge: Cambridge University Press. 19

SCULL, Andrew T. (1979). Museums of Madness. 1 ed., London, Penguin Books.

!2

implemented as early as 1409, (Porter, 199720) at Valencia’s Santa María de los Inocentes- recognised as the first specialised hospital for the mentally ill in 1410. This was introduced into English psychiatric care much later. Bethlem continued to serve as a psychiatric institute and as a hostel for the poor. In 1536, the First Act of the Dissolution of the Monasteries sought to close all religious foundations (Dickens, 198921). As Bethlem served as an attached hospital to St. Mary of Bethlem, the site was spared and allowed to continue practice as a place of refuge for the destitute. A decade later, King Henry VIII signed Bethlem’s endowments to the City of London, which controlled Bethlem under the umbrella management of the governors of Bridewell House of Correction, established in 1550 (Howard, Hitchcock & Shoemaker, 201222). The City of London continued to rule Bethlem through the rest of its 400 year history, including under surveillance by the Metropolitan Asylums board (established by the Metropolitan Poor Act 1867) until their abolition in 1930 (Rivett, 201323), where it was replaced in favour of a new governance: the National Health Service, in 1948 (Allderidge, 197924). The image below depicts a map, dating back to 1559 and is the only known etching of the original Medieval Bethlem Hospital buildings in situ.

! ! ! ! ! ! 20

PORTER, Roy (1997). The Greatest Benefit to Mankind: A Medical History of Humanity from Antiquity to the Present. London: Fontana Press. 21

DICKENS, Arthur Geoffrey (1989). The English Reformation (2nd ed.). London: B. T. Batsford. 1-511.

22

HOWARD Sharon, HITCHCOCK Tim & SHOEMAKER Robert (2012)’Bridewell Prison and Hospital’ in London Lives 1690-1880- Crime, Poverty and Social Policy in the Metropolis http://www.londonlives.org/static/Bridewell.jsp#toc2 Last Accessed: 8th Apr 2014. 23

RIVETT...