Asylums have always been associated with adjectives such as terrifying, dark, grisly, etc. Mental health was considered an iniquity by commoners and health professionals in the early times. The architectural design of asylum was associated with that of a prison stating incarceration, control, or repression by common men, designers as well as doctors in the older times. This gradually changed when mental health was given emphasis and brought out of being a taboo. With evolving theories of caring for the mentally ill since the 19th century, the architecture of havens for the insane started to unfold. Further, these buildings became mixed-use development, along with offices and other spaces with rehabs. Many doctors believe that architecture plays a very crucial role in the mental being of any person. Hence, architecture becomes a compelling factor in rehabilitation for mental illnesses.
Before the 19th century, mentally challenged people were believed to be victims of sins from a past life, under the possession of the devil or other such superstitious beliefs. They were not accepted even on the streets, let alone their own homes. Hence, the number of vagabonds on the streets began to rise. In an attempt to tackle this, the government started asylums, but the mentally challenged were not treated, rather confined and forced to labour to keep them from the civilized society. After the philanthropic revolution, mental illness came to the limelight as any other physical illness, and its requirement for medical attention was beginning to be accepted. A study says that 90% of cases of mental illness are curable if treated outside the home, which makes a point for the importance of asylums.
Many books such as ‘The Architecture of Madness: Insane Asylums in the United States’ (Carla Yanni, 2007), ‘The Lives They Left Behind: Suitcases from a State Hospital Attic’ (2009), ‘Asylum: Inside the Closed World of State Mental Hospitals’ (Christopher Payne, 2009), ‘Ten Days in a Mad-House’ (Nellie Bly, 1887), ‘The Art of Asylum-Keeping: Thomas Story Kirkbride’, ‘Origins of Modern Psychiatry’ (Nancy Tomes, 1994), ‘St. Elizabeths: A History’ (Thomas Otto, 2013), etc. described the life and challenges of patients in the asylum and with the help of real-life examples illustrated the role of a good design in the treatment of a mentally challenged person.
“Recognizing the need is the primary condition for design.” – Charles Eames
While learning the basic design, all architects are taught the emphasis that should be put on thermal comfort, light, and air ventilation in any building. The architecture for psychologically challenged does not differ but rather becomes sensitive. According to Jain Malkin in ‘The Architecture of Hospitals’, the Healing environment in hospitals is fabricated by a psychologically abetting setting in the physical organization. The emphasis of this arrangement should be towards reducing stress in the patients and their families alike whilst undergoing the treatment for the illness for sometimes coping up with the loss. There are no specific norms defined for this design aspect but an evidence-based design (EBD) approach can be considered. The key is to compose a stress-free space for the engaged users (medical staff, patients, visitors).
Many pieces of research have proved the role of nature to be crucial in stress reduction. It has been proved that prolonged exposure to natural light and either nature or imitation is effective to alleviate pain and depression. A low-noise setting creates a soothing environment for anxiety and allows a good sleep. Single bedrooms as a substitute to dormitories are the best possible way to achieve this. Replacing hardwood and tiled floors with carpets have also showcased an impact on the overall ambience.
One other consideration in an asylum is the safe-proofing of the milieu due to a suicidal tendency observed in many patients of the mental illness without compromising their right to privacy which was not mandated in confinements. Asylums should be a design ahead of their time. It should be able to tackle the overcrowding. A variety of elements to reinforce a living character to the city are arcades, patios, courtyards, pergolas, cloisters, and many such green, lit and lively transitional spaces. The mental hospitals in many countries had to face social challenges, poor resources, and neglect in the early period. The asylums are sometimes chosen to build on the outskirts of the cities due to a less commotion environment, fresh and clean air, and close to nature which is therapeutic in itself.
The treatment for mental illness happens in two processes, the first one is isolation from the environment that caused the illness, and the second, being the therapy. The site selection away from the city takes care of the first process. These sites were earlier chosen due to cheaper land and removal of the epileptic from society, but with advancements in medical therapies, this proved to be a boon for the patients. After the amelioration of medicine such as anti-depressants and anti-psychotic drugs, deinstitutionalization came into practice. Patients were not required to stay in the hospitals for longer periods.
After World War II, there was a lack of rehabilitation centres for after-treatment, which caused the patients to return to the hospital after a while, giving birth to the revolving-door effect. This was later embarked upon by introducing intermediate structures within the city limits. These structures are the daycare hospital which are daytime treatment clinics where residential treatment is not required, the daycare centres which focus on therapeutic activities such as gardening or cooking, sheltered workshops where patients are taught and rehabilitated with new skills to help them rejoin the society independently, or therapeutic clubs for ambulatory treatments. The introduction of these institutions within the city limits helps break the stigma around mental disorders in society. Some patients with mental disorders such as autism, dementia, mental retardation, etc., are untreatable and require residential treatments for life; this rehabilitation is their city within the city, a home. All of these structures vary in design requirements and user interfaces, but the patients and their mental well-being remain the primary considerations in the designing process of asylum.