Almost all nineteenth-century asylums built in the United States were modeled after the Kirkbride plan (named for Dr. Thomas Kirkbride, the superintendent of the Philadelphia Hospital for the Insane), which consisted of a central administration building flanked symmetrically by linked pavilions, each stepping back at right angles. This layout facilitated a hierarchical segregation according to sex, illness, and even social class. At present, only a few Kirkbride asylums still serve their original function. The very qualities that made them appealing in the first place—their enormous size, heavy construction, and distinctive floor plan—have made them difficult to repurpose. Buffalo is one of the few Kirkbrides to be preserved and adaptively reused. Designed by H. H. Richardson, construction began in 1871 and was not completed until 1895, although patients were admitted in 1880. By the 1970s, most of the patients had been moved to a new facility and the original complex was abandoned. Thanks to the efforts of local preservationists, elected officials, and community members, years of neglect have been reversed, and the building is being brought back to life as a hotel and conference center.
For more than half the nation’s history, vast mental hospitals—some of the largest structures ever built in America—were prominent features of the American landscape. From the mid-nineteenth century to the early twentieth, almost three hundred institutions for the insane were built throughout the United States. But in the second half of the twentieth century, after the introduction of psychotropic drugs and policy shifts toward community-based care, patient populations declined dramatically, leaving many of these massive buildings neglected and abandoned.
From 2002 to 2008, I visited seventy institutions in thirty states, photographing palatial exteriors designed by famous architects and crumbling interiors that appeared as if the occupants had just left. I also documented how the hospitals functioned as self-contained cities, where almost everything of necessity was produced on site: food, water, power, and even clothing and shoes. Since many of these places have been demolished, my photographs serve as their final, official record.
After my book Asylum was published in 2009, I thought I was finished with the project, but it continues to exert a strong emotional pull. Over the years, countless former patients, employees, and their relatives have reached out to thank me for telling this story. As I learn of more hospital closings and impending demolitions, I have been compelled to begin taking pictures again. I realize now that I will probably be working on Asylum, in some form or another, for the rest of my life.
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