In the course of my career as a psychologist, I have witnessed the closing of many of the hospitals but I have never seen a new one open. That is about to change with the scheduled opening of the new Worcester Recovery Center and Hospital in July of 2012. Every day is a step closer to the awakening of the sleeping giant that shares a hilltop with the last functioning building of Worcester State Hospital, a 1950s era, eight-story afterthought to the original 1876 structure destroyed in a 1991 fire. All that remains of the original hospital are the shells of an administration building, a turret and the hospital’s iconic clock tower. Beside these elegant remnants of the past, the new structure is stirring, breathing with exhalations of gray smoke from a modern heating system and keeping watch through windows illuminated late into each passing night.
I have had the opportunity to work in city and, by the standards of their time, rural hospitals built in three different centuries and designed according to the principles of prevailing ideas about the nature of illness and recovery. Cottage plan hospitals gave me the opportunity to do psychotherapy on long walks with patients through the open countryside. The design gained popularity at the very end of the nineteenth-century and continued to be very popular well into the twentieth. These hospitals are distinguished by a collection of small buildings, usually of no more than two stories, spread across large tracts of open land, far enough away from the stresses of city life to provide a restful, healing environment.
The cottage plan was inspired by the village of Gheel in Belgium where families traditionally opened their homes to pilgrims with mental illness who became part of the household, sharing in the work and daily life of their hosts. In my experience, this aspect of the cottage plan came to life in the emphasis these institutions placed on rehabilitation and the learning or re-learning of social and practical skills of daily living. Communal living in small houses gave patients the opportunity to work together with staff to plan and prepare meals, do necessary household chores and make excursions into the community that eased their transitions to life after discharge.
The antithesis of the cottage plan was the urban hospital where I did my pre-doctoral internship. From its founding in the early 1900s, this institution partnered with a university teaching and research center to promote the discovery of new knowledge and more effective treatment. Its philosophy of recovery also emphasized the advantages that patients enjoyed by remaining close to their families and not shunted aside to a remote country location where they risked being forgotten and further alienated from the world.
Kirkbride hospitals, whose name derives from the plan developed by psychiatrist Thomas Story Kirkbride in the middle part of the nineteenth century, in many ways combine the best features of cottage and urban institutions. They are typically situated in areas of natural beauty with extensive grounds, affording opportunities for rest, recreation, and productive activity. Unlike cottage plan hospitals, however, Kirkbride institutions are dominated by a massive building with a central administration area and two wings, segregated by sex, diagnosis and acuity of symptoms. Every section of every wing affords its residents access to fresh air and clear views of the surrounding countryside. At the same time, higher functioning patients are protected from what was thought to be the negative influence of less stable individuals by the segregation of patients according to their emotional and behavioral stability.
The new Worcester Recovery Center and Hospital occupies the site where the original Kirkbride building of Worcester State Hospital once stood. A graceful arc of three to four stories, it faces the clock tower in a symbolic expression of the new embracing the old. The building incorporates the latest thinking in hospital design as does every new hospital in every age. The new building maximizes natural light and views of the surrounding landscape. It minimizes noise with special carpet tiles and incorporates the ideal blend of privacy and communal living with residential units conceptualized as houses and clusters of units sharing the common space of neighborhoods. All of the neighborhoods look out onto a central atrium or downtown area containing some of the essential services and amenities of any community: a bank, convenience store, library and access to an outdoor village green.
The building will be ready for occupancy in July. Every day it begins to feel more like a living presence, its breath visible in plumes of smoke, its groans heard in the whirr of unnamed machinery. There is even a kind of intelligence that gleams in the evening lights from its windows. As for its soul, the lives that will be played out and the stories told within its walls – that is for us to begin to provide.
Alan Bodnar, Ph.D. is a psychologist at Worcester State Hospital and a consultant in the field of leadership development.