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
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.
therapeutic, restorative, mental health, landscape architecture,
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
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
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,
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 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 . . .
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;
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
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
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
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
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
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.
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
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.
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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
(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
(2) . Kankakee State Hospital was originally named Eastern Illinois
Hospital for the Insane.
(3) . Telephone conversation with Canadian Mental Health
Association, June, 1997.
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.
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