HHH column: Accepting the spatial potential of a problematic past by Eline Van Leeuwen

The HHH column is a monthly blog in which History, Health & Healing members share their thoughts on research, current affairs, or anything to do with medical history. Each edition is written by a different member – in due time, we hope to offer everybody a chance to publish a contribution. This month, the floor is for Eline Van Leeuwen, PhD candidate at the Technische Universiteit Eindhoven. Eline studies the relation between architectural atmosphere and patient experience, using her expertise as both architect and mental health nurse to do so. This column, accompanied by her own drawings of psychiatric institutions, suggests that the history of psychiatric spaces is characterised by a rejection of older typologies in favour of newer ones. Yet, this attitude may lead to the loss of valuable spaces.

Accepting the spatial potential of a problematic past

Eline Van Leeuwen

‘Thankfully the bad old days of psychiatry are behind us, right?’ In a HHH column published in April 2022, Joost Vijselaar, emeritus professor in the history of psychiatry, pointed out that psychiatry’s past is conveniently used to provide a ‘favourable enlightened perspective on the present’. Could it be that this strategy, which Vijselaar suggested may be a ‘universal psychological mechanism,’ extends beyond the realm of psychiatric treatments and philosophies but also informs the perception and design of psychiatric hospitals?

When psychiatrists, visitors, nurses and former patients describe their experience in psychiatric hospitals, they often evaluate present institutions or treatments in distinct juxtaposition with their historic antecedents.¹ In 1897, reporter C.K. Elout described Meerenberg, the first 19th-century newly built Dutch asylum, as having a ‘friendly and free appearance’² and as being embedded in its surroundings ‘like someone fallen backwards into a dune grove’³ meeting the visitor with ‘spaciousness and quiet’ upon entering the building.⁴ In her retrospective reflection on the institution, Anny op der Heijde, a nurse in training at Meerenberg (1893-1895), instead described the institute as ‘a square, grey building’ that did not look cheerful and from which distant sorrowful sounds arose, ‘as if people were in distress.’⁵ She remembered the interior of the building as ‘a great noise of cursing, ranting and fighting’ and containing cells wherein ‘the ill were sometimes naked and smearing feces on the wall.’⁶ When revisiting her old work environment in 1940, she praised the improved practices (such as active therapy and leisure) and conditions, emphasizing that the cells were no longer there and that one could no longer hear the mournful sounds.⁷ Naturally, Elout and Op der Heijde saw the asylum through their respective relationships to it; Elout, unlike Op der Heijde, did not have to work there. Still, their contrasting descriptions of the asylum’s space, Op der Heijde’s comparison between an unfavourable past and a better present, may point to a broader trend in how the spatial qualities of psychiatric hospitals (such as appearance, spaciousness and noise) are perceived. Roseate depictions of a particular environment are often at odds with retrospective critiques of the same building from later periods.

Juxtaposing the old with the new, however, risks to be done at the expense of careful evaluation and nuance. This attitude may have even affected views about the design of new hospitals. In fact, designs of psychiatric hospital typologies have often departed quite radically from the designs of preceding institutions. The massive carré-corridor system of Meerenberg (built 1844-9), was designed not to resemble a prison or dungeon in any way, thus contrasting previous psychiatric environments.⁸ It was embedded in nature and had large windows without heavy bars.⁹

The pavilion system (ca. 1880-1920) downscaled the ‘massiveness’ of the carré-corridor system, ‘replacing a single monolithic building with a complex of smaller ones’ where ‘high fences or walls’ could be avoided.¹⁰ The smaller scale of the pavilions allowed for creating a more ‘homely’ environment, opposed to the large wards in the carré-corridor system.¹¹ Hereafter, the sanatorium typology (ca. 1920-40) provided a more luxurious and modern care environment, modelled after the modern (general) hospital¹² in an attempt to get rid of the negative connotation of the overcrowded 19^th century asylum.¹³

In the second half of the 20^th century, focus gradually shifted towards decentralization, prevention and local care.¹⁴ Regular terraced houses, called ‘socio housing’ and modern high rise flats were built to resemble ‘regular architecture’ and blend in with the urban environment.¹⁵ In the attempt to break down barriers between the institution and society, these typologies distinctly turned away from the architecturally differentiated psychiatric hospital. The successive spatial reinventions seem to produce architectural form that gradually rids itself of any exceptional characteristics.

Indeed, the recent shift towards ambulatory care¹⁶ suggests that the psychiatric hospital succeeded in approximating the ‘healthy’ populations’ spatial environment up to the point of making itself practically redundant. This is remarkable, considering that various of the old psychiatric hospitals are getting redeveloped for high-end luxury housing, suggesting that they do in fact contain some spatial quality or atmospheric value. Residences in the Carré Bloemendaal, the former Meerenberg, are selling for as much as 2 million euros on Funda and in the Noorder Sanatorium for around 700.000 euros. Some advertisements even jokingly refer to the building’s psychiatric history, stating that ‘you are crazy if you don’t want to live here.’¹⁷

Could it be that past rejections of design approaches have been motivated by the psychiatric hospital’s negative image or regime, rather than its spatial quality¹⁸ per se? In other words, have psychiatrists and designers of the past dismissed older spatial typologies because they illustrated a ‘flawed’ or ‘obsolete’ psychiatric past, and not necessarily because they were altogether unfit for patients? Could this have led to inordinately harsh judgements of existing psychiatric hospitals, rejecting them prematurely throughout history – and valuable spaces being irretrievably lost in the present sell-off? One could entertain the thought of evaluating psychiatric hospital environments as complementary rather than in juxtaposition to one another, acknowledging how different spatial qualities may provide a range of potential without being mutually exclusive, catering to a variety of different needs and preferences amongst psychiatric patients. Depending on a variety of contextual factors (personal, medical, social and more), one may sometimes need the secure enclosure of a court yard and at other times appreciate the expansive width of the rural landscape.

1 [Psychiatrist and medical director of Meerenberg:]J. Deventer, van, Krankzinnigenverpleging in de eerste helft der vorige eeuw (Amsterdam: Van Heteren, 1901). [English psychiatrist and visitor to Meerenberg:] D.H. Tuke, ‘The Asylums of Holland: Their Past and Present Condition.’ 7, no. 27 (1 July 1854): 445-467. [Publicist:] E. Gerdes, Meerenberg en de krankzinnigen (Sneek: J.J. Wiarda, 1876); [Journalist:] C.K. Elout, ‘In Meerenberg’, Woord En Beeld 2, no. 2 (1897): 158–77; 193–212. [Nurse in training at Meerenberg:] A.M.P. Putten – op der Heijde, van der, ‘Verleden En Heden’, Tijdschrift Voor Ziekenverpleging, no. 51 (1941): 66–73. [Former patient of the Willem Arntsz Hoeve and writer:] F. Dommisse, Opdat er kieme … : beschouwingen over de gestichtsverpleging van geesteszieken (Rotterdam, 1939).

2Elout, ‘In Meerenberg’, 197.

3Elout, 193.

4Elout, 194.

5Putten – op der Heijde, van der, ‘Verleden En Heden’, 67.

6Putten – op der Heijde, van der, ‘Verleden En Heden’, 70; Putten – op der Heijde, van der, ‘De Heilzame Invloed van: Arbeid Voor Geesteszieken.’, 237.

7Putten – op der Heijde, van der, ‘Verleden En Heden’, 70; Putten – op der Heijde, van der, ‘De Heilzame Invloed van: Arbeid Voor Geesteszieken.’, 237.

8N. Mens, De architectuur van het psychiatrisch ziekenhuis (Wormer: Inmerc, 2003), 19–21, 162; J. Vijselaar, Krankzinnigen gesticht : psychiatrische inrichtingen in Nederland 1880 – 1910 (Bussum: Unieboek, 1982), 13–14.

9J. Vijselaar, Gesticht in de duinen : de geschiedenis van de provinciale psychiatrische ziekenhuizen van Noord-Holland van 1849 tot 1994 (Hilversum: Verloren, 1997), 38.

10J.E. Moran, L. Topp, and J. Andrews, Madness, Architecture and the Built Environment : Psychiatric Spaces in Historical Context, Routledge Studies in the Social History of Medicine (London: Routledge, 2011), 246.

11Mens, De architectuur van het psychiatrisch ziekenhuis, 111.

12Mens, De architectuur van het psychiatrisch ziekenhuis, 133; Mens and Wagenaar, Health Care Architecture in the Netherlands (Rotterdam: NAI Publishers, 2010), 58.

13Vijselaar, Krankzinnigen gesticht psychiatrische inrichtingen in Nederland 1880 – 1910, 17; Mens, De architectuur van het psychiatrisch ziekenhuis, 109.

14Mens, De architectuur van het psychiatrisch ziekenhuis, 257.

15Mens, 186.

16Ambulatory care is defined by Mosby’s dictionary of medicine, nursing & health professions as ‘health services provided on an outpatient basis to those who visit a hospital or clinic and depart after treatment on the same day.’ Mosby Inc, Mosby’s Dictionary of Medicine, Nursing & Health Professions, 9th ed (St. Louis: Elsevier, 2013).

17https://www.rtvdrenthe.nl/nieuws/165802/inrichting-zuidlaren-wordt-appartementencomplex-je-bent-gek-als-je-hier-niet-wilt-wonen

18Spatial quality: the perceived meaning or value of a space, in accordance with certain use or purpose. See Rapoport, (1970) for further reading. In architectural terms, various relevant determinants for evaluations include form, scale, proportion, organization, circulation (Ching, 2023); but also rhythm, daylight, colour, sound and texture (Rasmussen, 1986).

References

Ching, Francis D. K. ‘Architecture : Form, Space, and Order’. Eng. Newark: Wiley Newark, 2023.
Deventer, van, J. Krankzinnigenverpleging in de eerste helft der vorige eeuw. Amsterdam: Van Heteren, 1901.
Dommisse, F. Krankzinnigen. De Salamander. Amsterdam: N.V. Em. Querido’s Uitgeverij, 1950.
Dommisse, F. Opdat er kieme … : beschouwingen over de gestichtsverpleging van geesteszieken. Rotterdam, 1939.
Elout, C.K. ‘In Meerenberg’. Woord En Beeld 2, no. 2 (1897): 158–77; 193–212.
Gerdes, E. Meerenberg en de krankzinnigen. Sneek: J.J. Wiarda, 1876.
Mens, N. De architectuur van het psychiatrisch ziekenhuis. Wormer: Inmerc, 2003.
Mens, N. and Wagenaar, C. Health Care Architecture in the Netherlands. Rotterdam: NAI Publishers, 2010.
Moran, J.E., L. Topp, and J. Andrews. Madness, Architecture and the Built Environment : Psychiatric Spaces in Historical Context. Routledge Studies in the Social History of Medicine. London: Routledge, 2011.
Mosby Inc. Mosby’s Dictionary of Medicine, Nursing & Health Professions. 9th ed. St. Louis, Mo.: Elsevier/Mosby St. Louis, Mo., 2013.
Putten – op der Heijde, van der, A.M.P. ‘De Heilzame Invloed van: Arbeid Voor Geesteszieken.’, no. 51 (1941): 236–41.
Putten – op der Heijde, van der, A.M.P. ‘Verleden En Heden’. Tijdschrift Voor Ziekenverpleging, no. 51 (1941): 66–73.
Rapoport, Amos. ‘The Study of Spatial Quality’. Journal of Aesthetic Education 4, no. 4 (1970): 81–95. https://doi.org/10.2307/3331287.
Rasmussen, Steen Eiler. Experiencing Architecture. 19th print. Cambridge: MIT Press, 1986.
Tuke, D.H. ‘The Asylums of Holland: Their Past and Present Condition.’ 7, no. 27 (1 July 1854): 445-467.
Vijselaar, J. Gesticht in de duinen : de geschiedenis van de provinciale psychiatrische ziekenhuizen van Noord-Holland van 1849 tot 1994. Hilversum: Verloren, 1997.
Vijselaar, J. Krankzinnigen Gesticht Psychiatrische Inrichtingen in Nederland 1880 – 1910. Bussum: Unieboek, 1982.