Abstract
This paper contributes to understanding the origins of designing landscapes in support of mental health by examining early influences and practice in Ontario. Connections are made with respect to the history of therapeutic landscapes, the restorative landscape movement and the contributions of early medical practitioners. The design of Lakeshore Psychiatric Hospital in Toronto, created more than one hundred years ago, provides insights into the form and use of landscape for restorative and therapeutic purposes. Recent adaptive use of the Lakeshore Hospital grounds suggests a continuing link between recreational and therapeutic use of landscape in support of mental health. Conclusions focus on the relevance of restorative and therapeutic landscape history to contemporary landscape architectural practice. Cet article met en lumiere les debuts de l'architecture paysagere comme outil d'aide a la sante mentale en examinant les premieres influences et manifestations de ce courant en Ontario. Des liens sont traces entre l'histoire d'environnements therapeutiques, le mouvement pour la restauration du paysage et les premieres contributions des medecins praticiens dans ce domaine. L'hopital psychiatrique Lakeshore de Toronto, fonde il y a plus d'un siecle, est un exemple d'environnement amenage a des fins de retablissement et de therapie. La conservation integree du terrain de l'hopital Lakeshore effectuee recemment demontre que l'amenagement d'un territoire, s'il est concu de facon a en reunir les fonctions recreative et therapeutique, peut favoriser l'aide a la sante mentale. Pour conclure, on souligne la necessite de connaitre l'histoire de ces pratiques, qu'il s'agisse de restauration ou d'amenagement therapeutique, pour les architectes paysagers contemporains. Key Words therapeutic, restorative, mental health, landscape architecture, cultural landscapes As interest grows in alternative, cost-effective forms of health care, the role of landscape in support of human health is being examined by medical practitioners, environmental psychologists, landscape architects and others. Landscapes have been used in the treatment of patients with mental illnesses since the 1400s (Warner, 1995) and were an integral part of mental health institutions in Europe and the United States in the eighteenth and nineteenth centuries (Kirkbride, 1880; Illinois, 1885; Jaffary, 1942). Although public records indicate that landscapes formed an important part of Canadian mental health institutions in the 1800s, details on the origins, design and use of the outdoor environment as part of these therapeutic facilities have not been fully documented. It is the purpose of this paper to contribute to an understanding of the origins of therapeutic landscape design in Canada, emphasizing development in the province of Ontario. Included are a discussion of concepts relevant to therapeutic landscape design, a summary of early influences in the development of mental institutions in Ontario, an overview of the design of Lakeshore Psychiatric Hospital as a major therapeutic landscape, a synopsis of recent adaptive use proposals for the hospital grounds, and observations on the relevance of therapeutic landscape history to landscape architectural design practice today. Design Origins The concept and form of therapeutic landscapes is closely related to that of restorative environments. Both can be seen as part of a continuum of landscapes capable of supporting human health and well-being. In the case of restorative landscapes, user stimulation and enjoyment are primary objectives resulting from human interaction with the environment, interaction that may be as much psychological as physical. Therapeutic landscapes, on the other hand, are designed in support of specific forms of treatment and wellness, typically achieved through direct interaction between patients and the landscape. The design of landscape as a restorative environment was central to much of Frederick Law Olmsted's work. The father of landscape architecture in the United States, Olmsted was for a short time Secretary of the U. S. Sanitary Commission, the predecessor of the American Red Cross (Newton, 1971). He believed fervently in the curative powers of nature and consistently translated this philosophy into his designs for public parks, open spaces and institutions (Kavanagh, 1994). Common features of Olmsted's executed works included lawn and meadow spaces extended by visual connections, extensive plantings of canopy trees and shrubs, incorporation or creation of "natural" areas, and separate vehicular and pedestrian circulation systems typically designed in curvilinear patterns. The premise that landscape was capable of restoring the human mind and body was also an underlying influence in the development of mid- and late-nineteenth century designed public landscapes in Ontario. Rural cemeteries (McKendry, 1998), urban pleasure parks (Wright, 1983) and provincial schools for children with disabilities (Crawford, 1986) all embodied restorative landscape design principles (Figures 1 and 2). These designed landscapes incorporated many of the same features found in Olmsted's work: expansive spaces, extensive planting, naturalistic areas, and curvilinear, separated circulation systems. The Role of Early Hospital Superintendents Concurrent with the conceptualization and development of landscapes as restorative environments, medical practitioners began to experiment with using landscapes for therapeutic purposes, especially in the treatment of patients with mental illnesses. The form of nineteenth-century mental asylums, or insane asylums as they were called in the 1800s, was heavily influenced by the asylum superintendents. These superintendents were actually medical doctors, the predecessors of today's psychiatrists (Jaffary 1942). The connection between the superintendents' interest in the treatment of mental illness and the design of physical environments in the mid-1800s is described by Brown (1980: 110): Insanity, the prevailing psychiatric orthodoxy held, was an organic brain disease, but it was most often brought on by "moral", i.e. psychological stresses in the environment. It followed therefore that if insanity was the product of a faulty social environment it could be cured by placing the insane in a controlled "therapeutic" environment, an asylum. It was for this reason that such lavish attention was devoted to every detail of asylum architecture. Everything about the asylum was to be "therapeutic". Architects and landscape architects played an important role in interpreting design intentions, but it was the superintendents who appear to have taken the lead in determining the form of early mental health facilities. Resulting mental asylums were planned as self-sustaining communities that relied on patients for the management and cultivation of land as part of their therapy. Late nineteenth-century mental asylums in the United States and Ontario incorporated the use of land for treatment and production with restorative landscape settings to create a distinctive form: the therapeutic landscape. Dr. Thomas Kirkbride was a central figure in the design of mental asylums in the nineteenth century (Carter, 1986). When Ontario began building its first asylums in 1850, John Howard, the provincial architect, travelled to the United States to study state-of-the-art facilities. There he met Dr. Kirkbride, then superintendent of the Pennsylvania Hospital for the Insane, who first recorded his ideas for the design of "insane asylums" in 1854. (1) Kirkbride's ideas are described as having influenced the design of numerous asylums in the United States and several in Ontario (Carter 1986; Chappell, 1995). The development of design plans for hospital grounds was strongly encouraged by Kirkbride (1880: 53): "As soon as a building is located, a general plan for the improvement of the grounds should be prepared, and the laying out of roads and planting of shade trees commenced." He promoted what would today be described as good site planning principles, addressing building location, prevailing winds, sun, drainage, views, and visual sequence and hierarchy. Kirkbride summed up his belief in the need to plan the therapeutic site: "Not to do this, is neither wisdom or economy" (1880: 54). Addressing the potential contribution of landscape to the improvement of the mental health of patients, Dr. Kirkbride recommended the following: The grounds about the building should be highly improved and tastefully ornamented; a variety of objects of interest should be collected around it, and trees and shrubs, flowering plants, summer-houses, and other pleasing objects, should add to its attractiveness. No one can tell how important all these may prove in the treatment of patients, nor what good effects may result from first impressions thus made upon an invalid on reaching a hospital . . . (1880: 53). The London Asylum for the Insane in London, Ontario, which opened in 1870, provides an early example of therapeutic use of landscape. The asylum's medical superintendents, Dr. Henry Landor and Dr. Richard Bucke, established "a progressive therapeutic program of gardening and farming through the incorporation of orchards, gardens and farm fields" and in the latter 1800s the site was further "improved to provide for beautification and recreation" (Behr, 1995). Horace W.S. Cleveland, a well-known Chicago landscape architect, designed the landscapes of two American mental asylums: Mount Pleasant Hospital in Iowa in 1871 and Kankakee State Hospital in Illinois in 1879 (Chappell 1995). (2) At Mount Pleasant, Cleveland involved patients in planting native trees and shrubs as part of their therapy (Barton, 1989). Restorative design elements still evident in the Kankakee site include separated, curvilinear roads and paths, extensive plantings of canopy trees, and large expanses of lawn providing long views to the nearby river (Paine, 1997b) (Figure 3). Under the direction of the asylum superintendent, a new concept of cottage style buildings oriented to "neighbourhood" streets was introduced in a later phase of the Kankakee development, with the intention of creating a "village" atmosphere (Chappell, 1995). Cleveland's contribution to the character of these streets and the landscape as a whole is particularly relevant as Kankakee State served as the model for design of Lakeshore Psychiatric Hospital in Ontario (Carter, 1986; Chappell, 1995). The Landscape of Lakeshore Psychiatric Hospital The dominant characteristics of nineteenth-century therapeutic landscape form are found in the history and evolution of Lakeshore Psychiatric Hospital, located on the north shore of Lake Ontario in Etobicoke (Figure 4). This site provides an example of a fully executed therapeutic landscape design that combined a restorative landscape setting with the intended use of land for patient therapy (Cecelia Paine and Associates Inc., 1996). Today this site is part of the urban fabric of the Toronto region, surrounded by a population of 4.5 million people. Construction of Lakeshore Psychiatric Hospital, originally called Mimico Hospital for the Insane or Mimico Asylum, began in the late 1880s and patients were first admitted in 1889. Although the design for this fifty-two hectare site was a product of collaboration between administrators and design experts, the central philosophy and direction was determined by Dr. D. K. Clark, the superintendent of the hospital at its inception. Dr. Clark had investigated several mental asylums in the United States and advocated using the Kankakee State Hospital model in developing the Lakeshore site (Carter, 1986). Among the design features borrowed from the Kankakee site were a centrally-located administration building, creation of a village-like character, development of a system of cottages that permitted flexibility in the accommodation of patients, and acquisition of sufficient and suitable land to permit the involvement of patients in day-to-day construction, maintenance and production activities as part of their therapy. Dr. Clark worked closely with Kivas Tully, the provincial architect, in the design of the buildings and with Samuel Matheson, a landscape gardener, in the development of the landscape. Both the buildings and landscape were carefully planned to provide optimum conditions that integrated the physical environment with the care and treatment of patients. Hospital administrators were proud of this new institution, as suggested by their production of a turn-of-the-century postcard that captured the Lakeshore Hospital buildings and grounds (Figure 5). Classic features of nineteenth-century restorative landscapes are exhibited in the Lakeshore Hospital grounds, created between 1892 and 1911. These features include curvilinear roads leading to the central site buildings, extensive planting of ornamental trees and shrubs, creation of "natural" areas, and expansive lawns and open spaces with long views to water. Beyond serving as a setting, however, the landscape was clearly intended to accommodate a program of patient therapy. By this time, therapeutic activities connected to landscape were classified landscaping companies as one of three types: industrial, occupational and recreational (Paine, 1997b). A number of distinct landscape areas were created within the hospital grounds, each intended to be used for different forms of patient therapy or constructed by patients as a result of what were referred to in the superintendents' annual reports as "therapeutic activities". Collectively, these landscape units were intended to create an environment supportive of human health and wellbeing. The Cottages and Administrative Complex. The centrally located cottages and administrative/service complex were the centre of daily life. The northern cottages were for male patients, the southern ones for females. The landscape was designed to provide a home-like setting, with intensive development of floral beds and foundation plantings, and canopy trees lining the walks and drives. The intention was to establish a home-like character, employing a Victorian-style landscape treatment in vogue at the time. Patients were encouraged to use this part of the grounds for sitting and strolling. Maintenance of the flower beds was undertaken by patients as part of their therapy. The Amusement Ground. The amusement ground was an open, sunny area that served as the primary facility for outdoor recreational therapy. Circular in form, it was originally designed for playing cricket, but also accommodated tennis and croquet. The perimeter walking path surrounding the cricket pitch was also used for horse-racing at one time. The Lakeshore. The lakeshore area was a centre for passive forms of recreational therapy, conducive to conversation and reading. It was likely the most interesting place within the hospital site, located adjacent to the shoreline with southerly views to activity on the water and northerly views to the amusement ground and women's cottages. Both a men's pavilion, which still exists, and a women's pavilion were constructed within this area, capitalizing on the location (Figure 6). The Park. The park, located adjacent to the lake, was intended to provide patients with a sense of privacy and seclusion, where they could mentally escape from the more public, institutional atmosphere of the site. Shady, intimate spaces were designed to contrast with the large, sunny open character found elsewhere on the site. Trees were planted in a naturalistic style to establish a park-like feeling. Patients were encouraged to use this area for strolling and observing the "natural" environment as part of their recreational therapy. The Ravine. The ravine was originally the location of a natural creek. The side slopes and creek bottom were reshaped using patients labour. This "improved" and planted area was highly visible from the main entrance drive. Patient construction of this landscape area was considered a form of occupational or industrial therapy. The Garden. The garden supplied food to hospital patients and staff. Patients tended vegetables and soft fruits, such as raspberries. Their work here was considered a form of occupational therapy. The Farm. The farm was added later as the final component of the therapeutic landscape concept. At its peak, it accommodated poultry, pigs and cows and included an orchard, soft fruit production, fields of potatoes, and land used for pasture and hay production. Reports indicate that male patients vied for opportunities to participate in farm duties, another type of occupational and industrial therapy within the Lakeshore facility. The Pathways. The pathway system was designed for patient, staff and visitor access, as a facility for patient exercise, and to accommodate service vehicles when needed. Many of the paths and sidewalks were tree-lined, providing shade Evolution in Treatment and Landscape In the 1970s, governments across Canada and the United States began to discontinue residential care of mental health patients, promoting the use of drugs and out-patient treatment instead. As a result, many institutions were closed or partially adapted for other uses. In the case of Lakeshore Psychiatric Hospital, health services provided on the site are now limited to an out-patient mental health clinic and a drug rehabilitation centre, administered from two of the original hospital buildings. Several of the patient cottages garden landscape ideas now accommodate educational programs affiliated with a community college located on land that was formerly the hospital farm. Creation of a marina and boating facility on fill in Lake Ontario has altered the original shoreline of the site. The farm area has changed the most over the past fifty years: in addition to the community college, it also incorporates a regional water filtration plant and a seniors' residence. Despite this evolution, the design integrity of the core of the original mental hospital remains intact. Through recent master planning efforts the Lakeshore Hospital site is evolving from a therapeutic landscape emphasizing treatment of patients to a restorative setting supporting the health and well-being of urban residents (Moore George Associates, et al., 1996). Recreational activities, one of the forms of patient therapy in the original design, will be the dominant program to be accommodated within the central hospital grounds, requiring only minor physical modifications. Conclusions It is significant to note that one in six Canadians is expected to suffer from some kind of mental illness during their lifetime. (3) Recognizing these and other health needs of society, the following observations are made that link the history of restorative and therapeutic landscapes to the contemporary practice of landscape architecture. These observations focus on the landscape architecture profession's interests in research, design and conservation. In the 1800s, asylum superintendents drew on their scientific knowledge and expertise to influence the form of therapeutic facilities. Today, emerging environmental, psychological and medical research has the potential to provide insights and direction in the development of physical form conducive to improving mental health (Paine, 1997a). Kaplan and Kaplan's (1989) model of restorative environments, Ulrich's (1984) work on the role of landscape in promoting patient recovery, and design-based research focused on Alzheimer's (Mooney and Hoover, 1996), psychiatric (Narayan and Muenzler, 1997; Langer, 1987) and schizophrenic patients (Larsen, 1991) are just some of the important studies that provide relevant information and ideas. As professionals, landscape architects need to support and utilize such research in the practice of creating both therapeutic facilities and restorative environments. Reflecting on the legacy of Olmsted, the critical role of landscape architects continues to be that of creatively translating philosophy and science into meaningful physical form. Just as landscape architects took knowledge concerning the needs of the physically challenged and translated it into design accessibility standards in the 1970s and design solutions in the 1980s, they now need to seize the opportunity to work with health professionals and others to translate human psychological needs into physical environments supportive of mental health and well-being. Finally, landscape architects have an important role to play in conserving restorative and therapeutic landscapes created in the past. They are among the few in society who can look at early designed landscapes and sense their significance. To be effective in the role of conservator, they must begin by seeking to learn the history of the landscapes around them. Landscape architects can use this knowledge of history to promote the heritage value of designed landscapes and to sensitively adapt therapeutic and restorative qualities from the past for the use and enjoyment of people today and in the future. Endnotes Langer, L. 1987. Therapeutic Landscapes: Preferences of Psychiatric Patients. Master of Landscape Architecture thesis. University of Guelph: School of Landscape Architecture. Larsen, L. 1991. Nature as Therapy: An Assessment of Schizophrenic Patients' Visual Preferences for Institutional Outdoor Environments. Master of Landscape Architecture thesis. University of Guelph: School of Landscape Architecture. McKendry, J. 1998. "The Rural Cemetary Movement in Ontario: The Role of Cataraqui Cemetery, Kingston." In proceedings: Conserving Ontario's Landscapes, 6th Annual Conference. J. Beck, W. Moffet and K. Smith, eds. Toronto: Architectural Conservancy of Ontario. Mooney, P. and R. Hoover. 1996. "The Design of Restorative Landscapes for Alzheimer's Patients." In proceedings: 1996 Annual Meeting Proceedings, American Society of Landscape Architects. C. Wagner, Washington, D. C.: American Society of Landscape Architects: 50-55. Moore George Associates, du Toit Allsopp Hillier, and Cecelia Paine and Associates. 1996. The Lakeshore Grounds, Master Design and Implementation Plan. Etobicoke: Planning Department. Narayan A. and G. Muenzler. 1997. In proceedings: 1997 Annual Meeting Proceedings, American Society of Landscape Architects. C. Wagner, eds. Washington, D. C.: American Society of Landscape Architects: 206-210. Newton, N. 1971. Design on the Land, The Development of Landscape Architecture. Cambridge: Harvard University Press. Paine, C. 1997a. "Creating and Re-creating Landscape for Therapy and Recreation." In proceedings: 34th IFLA World Congress. Centro Argentino de Arquitectos Paisajistas, ed. Article 25. Buenos Aires: International Federation of Landscape Architects. Paine, C. 1997b. "Landscapes for retaining walls Mental Health: Design and Adaptation of Early Psychiatric Hospitals." In proceedings: 1997 Annual Meeting Proceedings, American Society of Landscape Architects. C. Wagner, ed. Washington, D. C.: American Society of Landscape Architects: 211-215. Ulrich, R. S. 1984. "View Through a Window May Influence Recovery from Surgery." Science. 224:420-421. Warner, S. 1995. "Restorative Landscapes." Landscape Architecture. 85 (1):128. Wright, J. R. 1983. Urban Parks in Ontario, Part I. Toronto: Ontario Ministry of Tourism and Recreation. Author Biography Cecelia Paine, FCSLA, is an associate professor in the School of Landscape Architecture, University of Guelph. Her research and practice interests are in heritage landscape conservation, open space planning and design, cross-cultural design theory and practice, the contribution of landscape to quality of life, and contemporary Canadian design practice. She is a past-president of the Ontario Association of Landscape Architects and president-elect of the Canadian Society of Landscape Architects. She can be contacted at School of Landscape Architecture, University of Guelph, Guelph, Ontario N1G 2W1 ([email protected]). (1) . Kirkbride's ideas on design of insane asylums were first presented in 1854 as a series of propositions (Carter, 1986) and were later published in 1880 under the title On the Construction, Organization, and General Management for Hospitals for the Insane (Kirkbride 1880). (2) . Kankakee State Hospital was originally named Eastern Illinois Hospital for the Insane. (3) . Telephone conversation with Canadian Mental Health Association, June, 1997. Acknowledgements The author wishes to acknowledge the contributions of Pleasance Crawford, landscape historian, who undertook archival research on Lakeshore Psychiatric Hospital, and Rick Moore, landscape architect, who coordinated the master plan for adaptive use and development of the Lakeshore Hospital site. References Barton, C. 1989. "Institutional and Corporate Landscapes." In American Landscape Architecture, Designers and Places. W. Tishler, ed. Washington, D.C.: The Preservation Press, National Trust for Historic Preservation: 150-155. Behr, S. 1995. "London Psychiatric Hospital." Exhibit: Gardens of Pleasure and Contemplation. London Regional Art and Historical Museums, May 20 - November 5. Brown, T. 1980. "Architecture as Therapy." Archivaria. 10 (Summer): 99-123. Carter, M. 1986. Lakeshore Psychiatric Hospital, Etobicoke. Toronto: Ontario Heritage Properties Program. Cecelia Paine and Associates Inc. 1996. Lakeshore Psychiatric Hospital, Heritage Assessment and Conservation Recommendations. Etobicoke: Planning Department. Chappell, S. 1995. National Register of Historic Places Registration Form, Kankakee State Hospital Historic District. Washington, D. C.: National Register of Historic Places. Crawford, P. 1986. "Of Grounds Tastefully Laid Out: The Landscaping of Public Buildings in 19th Century Ontario." Society for the Study of Architecture in Canada Bulletin. 11(3): 3-7, 13. Illinois. Board of State Commissioners. 1885. Eighth Biennial Report of the Board of State Commissioners of Public Charities of the State of Illinois. Springfield: H. W. Rokker State Printer and Binder. Jaffary, S. 1942. The Mentally Ill and Public Provision for Their Care in Illinois. Chicago: University of Chicago Press. Kaplan, R. and S. Kaplan. 1989. The Experience of Nature, A Psychological Perspective. Cambridge: Cambridge University Press. Kavanagh, J. "People-Plant Principles from the Past." In proceedings: People-Plant Relationships, Setting Research Priorities. J. Flagler and R. Poincelot, eds. Binghamton, New York: Haworth Press: 231-238. Kirkbride, T. 1880. On the Construction, Organization and General Arrangements of Hospitals for the Insane. Philadelphia: State of J. B. Lippincott and Company. Reprinted 1973. New York: Arno Press Inc.
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