Thomas Story Kirkbride

Thomas Story Kirkbride was born to a family of Quaker farmers on July 31st, 1809 in Bucks County, Pennsylvania. His father deemed him too frail for farming but, recognizing his intelligence and sensitivity, encouraged him to pursue a medical career. At age eighteen, after completing his primary education, he began to study medicine under the tutelage of Dr. Nicholas Belleville in Trenton NJ. eventually being awarded a degree in medicine from the University of Pennsylvania in 1832.

Kirkbride wanted to be a surgeon which was the most prestigious and lucrative specialty in medicine. However, he was unable to gain residency at the Pennsylvania Hospital in Philadelphia and instead was, through family connections, offered residency at the Quaker run Friends Asylum for the Insane in Frankford, a small town on the outskirts of Philadelphia. Kirkbride accepted the position, not out of any particular interest in treating the insane, but as a springboard for his future candidacy at the Pennsylvania Hospital.

At Friends, Kirkbride observed and was impressed by the “moral treatment” of patients. Historically, the insane were considered incurable and were often chained to walls, unclothed, in a dungeon-like environment. Friends Asylum was progressive for its time, establishing a family atmosphere, removing physical restraints, and providing the patients with stimulating mental and physical activities. Kirkbride applied himself thoroughly and his superiors at Friends wrote of the “faithful and exemplary discharge of his duties”. Although his experience at Friends was rewarding and would prove invaluable in his future endeavors, he still longed to be a surgeon. His wish was granted when, in March 1833, he was offered a residency at the Pennsylvania Hospital. Elated, Kirkbride accepted immediately and left Frankford for Philadelphia with no thoughts of ever returning to the treatment of the insane.

Kirkbride’s performance at his new post was typically outstanding. He also nurtured a growing private practice which generously augmented his income. In both careers, he was known for his kindness and compassion in treating patients, sane or otherwise. This did not go unnoticed. In 1840 the Hospital Governors, based mostly on his exemplary record at Friends, offered him the position of Superintendent of the newly built Pennsylvania Hospital for the Insane. Kirkbride accepted, again, more for the prestige and financial security it offered than any personal desire to return to the treatment of the mentally ill. Yet, that is what he would do for the remaining 43 years of his life.

building as a cure

During our historical tours, hear about Dr. Thomas Story Kirkbride’s theory on what he referred to as the “moral treatment” of the insane, a constructive idea unique to the United States, for mental asylums from the mid to late 19th century.

Essential to the realization of his vision was moving patients from overcrowded city jails and almshouses, where patients were often chained to walls in cold dark cells, to a rural environment with grounds that were “tastefully ornamented” and buildings arranged “en echelon” resembling a shallow V if viewed from above. This design called for long, rambling wings, that provided therapeutic sunlight and air to comfortable living quarters so that the building itself promoted a curative effect, or as Kirkbride put it, “a special apparatus for lunacy.” These facilities were designed to be entirely self-sufficient providing the patients with a variety of outlets for stimulating mental and physical activities.

The Kirkbride plan influenced the construction of over 300 similar facilities throughout North America, some of which were designed by such luminaries as H. H. Richardson, Richard Snowden Andrews, and Fredrick Law Olmstead. However, the 20th century brought changes in treatment philosophy, deinstitutionalization, and more community-based treatment. The theory of “building as cure” was largely discredited. The expense of maintaining these facilities, combined with physical deterioration, has forced them to be mostly abandoned and many demolished.

The new superintendent totally immersed himself in the murky world of the insane, collecting and devouring everything written on the treatment and housing of the mentally ill. It was the buildings themselves that most interested him. He noticed aspects in the design of the new facility that he considered ill-planned in regard to creating a restorative ambiance and he began to envision a hospital environment that in itself, by its very design, would have a curative effect on its inhabitants.

By the early 1850’s the growing patient population was putting a strain on “Kirkbride’s Hospital”, as it had come to be known, giving Kirkbride an opportunity to realize his vision. He convinced the Hospital Governors to approve funds to build a new facility based on his theories. “The Kirkbride plan” was born and for the next several decades would influence the construction of some 300 mental asylums covering North America and Kirkbride himself would come to be known as the foremost authority on hospital design.

He was a founding member of the Association of Medical Superintendents of American Institutions of the Insane and served as its president for eight years. In 1854, Kirkbride published On the Construction, Organization, and General Arrangements of Hospitals for the Insane, which was quickly recognized as the definitive work on the subject and secured his reputation as one of the leading experts in the treatment of the mentally ill. Kirkbride’s work had a profound effect on his personal life as well. He survived an assassination attempt by one of his patients and married and raised a family with another. He died in Philadelphia on December 16th, 1883.