KIRKBRIDE, THOMAS (1809-83)

Kirkbride, a pioneer in American psychiatry, obtained his medical degree from the University of Pennsylvania, then served as physician in several mental institutions for eight years. In 1840 he became physician-in-chief of the Pennsylvania Hospital for the Insane, remaining there for the rest of his life. The period of forty years in which he served has been called “the Renaissance of American psychiatry.”Kirkbride played an important part in this renaissance. A Quaker, he brought to the hospital the same type of “moral treatment” that had been practiced by another member of The Society of Friends, William Tuke, in England around the turn of the century. He opposed the physical procedures which were still prevalent at the time—bloodletting, emetics, restraint—and insisted that the mentally imbalanced were not “wild beasts” to be put away in an asylum, but victims of diseases that should be treated in a hospital setting. He therefore had his patients engage in occupational therapy and attend religious services, lectures, and social gatherings. In contrast to the sadistic “keepers” of the time, his attendants were kindly individuals who awakened them with a cheerful greeting each morning and handled them on a human level throughout the day. Above all, a physician spoke with each patient every day,serving as a “father figure” who treated them with courtesy and understanding but expected full co-operation in return.Kirkbride was one of the original founders of the Association of Medical Superintendents of American Institutions for the Insane, the forerunner of the American Psychiatric Association. As secretary and later president of the association he collaborated with Isaac Ray on a series of resolutions adopted at annual meetings between 1824 and 1875. Here is a summary of these tenets, which have been termed the Magna Carta of the modern mental hospital:Insanity is a disease—to which everyone is liable.Properly and promptly treated it is about as curable as most other serious diseases.In a great majority of cases it is better and more successfully treated in well-organized institutions than at home.It is humanity, economy, and expediency for every state to make ample and good provision for all its insane.The best hospital—best built, best arranged, and best managed—is always cheapest in the end.A hospital should be plain, in good taste and well ventilated.A proper classification is indispensable.Overcrowding is an evil of serious magnitude.Abundant means for occupation and amusement should be provided.As little restraint as possible should be used.The insane should never be kept in almshouses or in penal institutions.Insane criminals should not be treated in ordinary state hospitals.There should be a qualified physician in undivided charge of each hospital. He should be responsible to a board of trustees of high personal character and without political motives.These resolutions focused attention on the need for adequate and efficient institutions for the huge number of mentally ill who were still being herded into county jails and almshouses. Kirkbride himself pioneered in this important field, and between 1847 and 1880 wrote a series of articles on hospital construction. His proposals, published as a book entitled On Hospitals, became known as the “Kirkbride Plan,” and until recently served as a bible for architects of state institutions.Kirkbride’s object was to “physicalize” the human treatment of patients by providing a maximum amount of fresh air and sunshine, with full attention to plumbing, heating, fireproofing, and kitchen facilities. His general plan, which called for a central building with extended wings, was widely adopted, and his description of details became what has been called a “set of cast-iron rules” to which hospital men rigidly adhered for many decades. While these rules contributed greatly to improvement in living quarters for the mentally ill, they also encouraged construction of huge, impersonal complexes in isolated locations. See JOINT COMMISSION ON MENTAL ILLNESS AND HEALTH, COMMUNITY MENTAL HEALTH CENTERS, MENTAL HOSPITAL.