Treatment: Examples from The Buffalo State Asylum
In mid-nineteenth century, the discussion on the advantages of Moral Management continued among physicians and reformers like Dorthea Dix, who traveled the country as an advocate for the humane treatment of the insane. In 1854, Dr. Thomas S. Kirkbride, Superintendent of the Pennsylvania Hospital for the Insane published Report on the Construction of Hospitals for the Insane.
The Kirkbride Plan, also known as the Linear Plan, described in detail the ideal hospital for the insane, including the site, location, landscaping, architectural design, ventilation, heating and lighting systems. A classic example can be found in the Buffalo State Asylum.
Kirkbride’s plan incorporated the design of the asylum into the patient treatment plans. He maintained that the ideal asylum would be located in the country, away from the stress, noise, and noxious miasma of the city. The property should be sufficient to allow for exercise, leisure activities, and outdoor work, all of which were critical aspects of mental health treatment. The asylum’s design consisted of a central administrative building with staggered wings on either side, for the separation of male and female patients. Each wing would house a different class of patient, with the most difficult cases furthest away from the center.
In its early decades, The Buffalo State Asylum was an acute care facility. Patients were encouraged, but not forced to assist in the upkeep of the farm or in other domestic chores such as the kitchen or laundry. They were also encouraged to exercise and socialize on the meticulously landscaped grounds. Although the institution was designed to house 600 patients, overcrowding soon became a problem. By the turn of the century, the facility averaged over 1,800 patients.
After the turn of the nineteenth century, The Buffalo State Asylum underwent a name change to the Buffalo State Hospital, reflecting the evolution in patient care. The institution, which had adhered so rigorously to the Kirkbride Plan incorporated changes to reflect a movement toward the Cottage Plan. This plan focused on separating specialized populations into separate buildings or cottages with a more domestic feel, unlike the Kirkbride model, which houses all patients under one roof, albeit in separate wards.
The Cottage plan was a reasonable solution to address the overcrowding that had been a problem since the 1890s. It also had the advantage of more efficiently separating specialized populations. Acute, convalescing, and chronic patients all had different needs. As treatments directed at specific types of mental illness emerged, the Cottage Plan also offered a more efficient setting for implementation.
Similarly, patients with infectious diseases, like tuberculosis, required separation. Tuberculosis was a major health threat in most American cities at the turn of the century and posed significant problems in public institutions. Another infectious disease which was a problem at the Buffalo State Asylum well into the twentieth century neurosyphilis. Malaria therapy was used to treat patients with neurosyphilis during the 1920s. Patients with tertiary syphilis were infected with Malaria, which would cure the syphilis, and then treated for Malaria. This treatment was used until the advent of penicillin in the 1940s.
Insulin shock therapy, a precursor to electro-convulsive therapy emerged for the treatment of schizophrenia (known then as dementia praecox). As early as the 1930s surgical solutions for schizophrenia were utilized. Although there were some lobotomies performed at the Buffalo State Hospital, neurosurgery was not commonly used there.
The mid twentieth century saw the advent of pharmaceutical treatments used for a number of mental illnesses, including schizophrenia, mania and other psychoses. Chlorpromazine (thorazine) was among the medicines most commonly used at the Buffalo State Hospital.
By 1965, the new 520-bed Nicholas J. Strozzi building was opened and over the next nine years, patients were gradually transferred from the old asylum buildings to the new facility. The Buffalo State Hospital underwent another name change to the Buffalo Psychiatric Center, again reflecting the continued evolution of mental health care. Throughout the ninety-four years of its existence, the institution underwent significant changes as innovations in mental health care emerged in its efforts to provide care for the patients it served. It is important to remember this evolution and the many people who were instrumental in its process to place the history of mental health care in true historical context.