In Independence, Iowa, on hundreds of acres of green grass stands a large Victorian mansion constructed of limestone and brick. The building is not a private home, a civic building or a historic landmark. It is the Independence State Hospital, a psychiatric institution that has operated since 1873.
In the late 19th and early 20th centuries, the hospital was also a farm — a landscape where patients would plant crops, garden and raise livestock, according to Nancy Tomes, author of “The Art of Asylum Keeping: Thomas Story Kirkbride and the Origins of American Psychiatry.”
According to Leanne Harrison, president of the Buchanan County Historical Society, the institute had more than a thousand patients farming when it first opened.
The patients’ tending of the land and food production enabled the institution to become self-sufficient and economically stable.
“They were kind of a self-contained mini town,” Harrison said.
Independence State Hospital was not the only mental institution where patients were put to work on the land as treatment for mental illness.
Developed by physician Thomas Story Kirkbride, 73 hospitals across the country were established throughout the late 19th century as an alternative to traditional mental institutions; before practitioners like Kirkbride, patients with mental illness were often housed in jails and almshouses.
“The plan was forged in his interest in making asylums more welcoming places again, arguably, because they were so scary,” Tomes said.
The Kirkbride Plan proposed large, symmetrical hospitals far from crowded cities with at least a hundred acres of land for farming and gardening.
The designs allowed patients to move through light-filled corridors, spend time outdoors and participate in daily activities, such as farming. These centers of care were especially popular in areas where land was abundant — like the Midwest.
According to Tomes, the actual work that patients did varied from region to region. In urban, wealthier areas like New Jersey, where the first Kirkbride hospital was established, gardening and walking were more common. In more rural and working-class areas, the work involved farming, plowing and working with livestock.
“Being in those outdoor environments can be a lot more restorative than being in an urban environment,” Whitney Fleming, a conservation social science researcher focusing on environmental psychology, said. “Specific outdoor activities can help with physical health [and] reducing rumination.”
On paper, Kirkbride’s plans for hospital farms promised restoration for people with mental illness. And, in practice, the patient experience did show some positive results.
“I definitely saw patients who liked being able to get outside into work, and who found being confined in the hospital boring and were eager to get out of those wards,” Tomes said, drawing on her patient record research.
But the plan was far from foolproof.
Many hospitals suffered from overcrowding and underfunding. As the hospitals rose in popularity, government funding and personnel struggled to keep up with growing demand.
According to Tomes, growing patient activism in the 1960s also raised concerns about the ethics of unpaid labor, ultimately leading to Supreme Court rulings against patient work in hospitals.
“The fact that they could no longer make patients work made them even more economically unsustainable,” Tomes said.
These systemic failures and social changes contributed to the gradual closure of all Kirkbride Plan hospitals by the 1970s.
Mark Ruffalo, professor of psychiatry and licensed clinical social worker, also attributed the closure of Kirkbride Hospitals to developments in psychopharmacology and the rise of prescription drugs, as well as a social movement against institutionalization and involuntary commitment.
Nonetheless, some of the less controversial concepts of Kirkbride’s hospital farms endure. Green space, fresh air and structured activities are a few of the practices that are now backed by research and increasingly implemented into patient care.
“I would take the patients out behind the hospital. I would help them grow plants and the patients loved it,” Ruffalo said of his work at a hospital in Pittsburgh. “I think there is some good evidence to show that getting patients to involve themselves in some work activity can be very helpful in their rehabilitation.”
Today, few Kirkbride hospital buildings remain in operation. Some of the Victorian mansions have been repurposed, and others have been left behind to deteriorate.
One of the few exceptions is Independence State Hospital. Now known as the Independence Mental Health Institute, the building is still used to treat those suffering from mental health conditions — and their on-site museum stands to preserve the slice of psychiatric history in which they took part.
