Modernism, Heal Thyself

Design as the Solution to Modern Madness

By Kyle Walker / Originally published September 21, 2017 in Public Books
Administrative building of Steinhof psychiatric hospital, now Otto-Wagner-Spital
Photograph by Thomas Ledl / Wikimedia Commons

Austria’s most famous asylum rises on regular terraces up the shallow slope of Vienna’s Gallitzinberg hill. Seen from the south, the asylum’s 60-odd buildings appear to merge, presenting a continuous facade of white walls and glistening windows crowned by an onion-shaped golden dome. The Lower Austrian Provincial Institutions for the Care and Cure of the Mentally and Nervously Ill “am Steinhof”—Steinhof for short—was an immediate sensation when it opened in 1907.

Excitement centered on the project’s lead architect, Otto Wagner, doyen of Austria’s forward-thinking architects and an early member of the Secession, Vienna’s Jugendstil art collective. But the mere scale of the project drew attention too: Steinhof exceeded every other asylum in Europe in both sheer size and number of beds. Spread out over more than 1,100 acres, Steinhof had enough space for five thousand patients, including separate pavilions for “quiet” and “noisy” patients, for “first-class”—i.e., paying—and indigent patients, for the merely “nervous” and the criminally insane.

Freedom and the Cage
This essay reviews "Freedom and the Cage: Psychiatry and Modern Architecture in Central Europe, 1890–1914," by Leslie Topp.

But Steinhof was not simply big, nor simply stylish. It represented a novel turn in thinking about both illness and physical space. At Steinhof, Wagner married architecture with medicine, applying modernist design solutions to diseases believed to stem from modernity itself. Steinhof thus stood at the forefront of two emerging movements in Austria-Hungary: liberal psychiatry and modern architecture. Strange bedfellows, to be sure, yet in turn-of-the-century Austria-Hungary the avant-garde prided itself on experimenting across fields. Indeed, doctors and designers saw themselves as working on parallel problems, and they plunged together into asylum design.

The era’s psychiatrists were fighting the psychic fallout produced by the frenetic pace of urban existence. The profession faced an epidemic of so-called “nervous” diseases, such as hysteria and neurasthenia, which were thought to be caused or exacerbated by overstimulation. Modernity brought speed, stress, and constant sensory bombardment—a perfect recipe for rattled nerves. To repair a shaken nervous system, doctors often prescribed a change of scene, sometimes coupled with baths, special diets, or exercise regimens. For the wealthy, that meant a stay at a health resort. For the poor and severely ill, it meant the asylum. Psychiatry had long resorted to segregation—of patient from nonpatient—in its efforts to confront mental illness, but doctors now discovered a new rationale for confinement: if urban life could cause a patient’s illness, it followed that removing the patient from the city might cure it.

Among Austria’s modernist architects, it was commonly held that modernity had arrived full force in cities still adjusting to a previous age—creating a perfect recipe for disorder and disease. Austria’s cities faced enormous population booms at the fin de siècle. Vienna’s population doubled between 1880 and 1900, its growth driven largely by immigration from the Czech lands—Bohemia, Moravia, and Silesia.1 These freshly minted and typically working-class city dwellers often found themselves in cramped, unhygienic quarters on Vienna’s outskirts, where tuberculosis was so common that the Viennese dubbed it the “proletarian disease.”2 Observers across the political spectrum—from Social Democrats, like Victor Adler, to nationalists, such as Adolf Hitler—agreed that the new urban life was taking a toll on the mental and physical health of the city’s laborers. Meanwhile, artists accused the built environment of encouraging anomie and malaise, as the structures that surrounded the modern man did not correspond to the new facts of his existence.

Austrian villa asylums projected monumentality. Steinhof in particular looks as though it were built to awe its patients into compliance.

Architects like Wagner responded by embracing those new facts—the very changes associated with this psychiatric dissolution—and remaking the environment to match. By the turn of the century, traditional architects had filled Vienna with new buildings made to look like they were constructed in the 15th, 16th, and 17th centuries. The neo-Gothic Rathaus, neobaroque Hofburgtheater, and neo-Renaissance main building of the city’s university—all displayed an obsession with historical revival that was characteristic of the era. Against this trend, modernist artists championed styles alive to the changes engulfing Austrian society. “The only possible point of departure for our artistic creation is modern life,” Wagner wrote.3 Because in his eyes modern man was essentially practical, Wagner devised a functionalist philosophy that (allegedly) subordinated art to purpose: nothing in a building should interfere with its function, its Zweck, a principle he summed up with the phrase “Something impractical cannot be beautiful.”

Wagner worked on quintessentially modern projects such as Vienna’s new metropolitan rail network. Most representative of his modernist outlook on the city was his modular design for an infinitely expandable metropolis—comprising a network of radially arranged semiautonomous units, connected by railways, with Vienna at the center—that he believed would relieve population pressure and improve hygiene.4 Wagner claimed that the architect could rescue city dwellers from the perils of ill-designed and ill-ventilated neighborhoods through enlightened planning, just as the psychiatrist could rescue his patients from the quasi-imprisonment of work and family life by confining them in an asylum.

Psychiatrists’ and architects’ thinking aligned in other ways too. Some psychiatrists saw the asylum as a model community to which the outside world could look for guidance, a utopic vision that jelled nicely with the master-planning impulses of Austria’s modernist architects. The asylums that Austria’s psychiatrists built in partnership with these architects were meant as trial runs at constructing ideal communities that would operate on an almost monastic logic: these were to be settlements where the mentally ill could heal, living apart from the world at large, in purpose-built structures based on the most modern principles. Confinement itself could produce a cure—as long as the physical and social conditions were right.

Imagining themselves as heirs to the 18th-century reformers who first released the mentally ill from their chains at Bedlam or the Salpêtrière, liberal psychiatrists promoted the villa asylum, a new treatment model rooted in modern ideas that promoted balancing autonomy and control. As Leslie Topp shows in Freedom and the Cage: Modern Architecture and Psychiatry in Central Europe, 1890–1914, Otto Wagner’s design for Steinhof reflected this new idea. In its plan, Steinhof departs from the older style of asylum, in which one sprawling structure, connected by an unbroken corridor, confined patients to life under a single roof. The so-called corridor asylum relied on locks and bars to control its patients; its high walls set it apart from the landscape. By contrast, the patients of a villa asylum lived in freestanding structures arranged within a landscaped campus. During a turn-of-the-century psychiatric building boom, Austrian officials erected seven villa asylums, part of a self-conscious effort by psychiatrists to separate their profession’s reputation from that of the increasingly deplored corridor asylum, which looked and felt like a prison.

But this design transition had a medical objective as well. Liberal psychiatrists contended that the corridor asylum exacerbated rather than cured mental illness. Although the mentally ill required a retreat from modern life, they argued, it did not follow that the asylum should rob patients of all their freedoms, that being the practical outcome of confinement in a corridor asylum. Albrecht Paetz, a psychiatrist who ran an early villa asylum in Germany, insisted that locks and bars demoralized patients and interfered with care. Paetz and the Austrian psychiatrists he inspired sought to create a place where the mentally ill would be as free as possible within confinement. This vision of organized liberty came to distinguish the modern Austrian asylum from its unenlightened forebears. As Topp points out, it was a model organized around what Michel Foucault called “caged freedom.”

The new asylums, Paetz and his colleagues insisted, should more closely resemble a settlement. The design of Paetz’s Rittergut Alt-Scherbitz studiously avoided all visible signs of confinement, employing locks no different than those used in ordinary houses. The buildings lay scattered irregularly at the edge of a nearby town. The patient pavilions resembled prosperous country dwellings, and even the floor plans were modeled on domestic living arrangements: sleeping quarters above, living spaces below. Paetz intended the homey atmosphere to keep patients calm and content, and therefore easy to manage and surveil. Alt-Scherbitz was designed to be a sort of rural utopia where patients could absorb the positive effects of a retreat from the city under the benign gaze of their doctors.

Steinhof seen from above
Steinhof as seen from above in 1932
Photograph by Walter Mittelholzer / Wikimedia Commons and ETH Zürich

Although many Austrian villa-asylum planners drew inspiration from Alt-Scherbitz, their projects often looked much different—and more institutional. Rarely did Austrian villa asylums house their patients as Alt-Scherbitz did. More often, patients slept and spent their days on a single level of the pavilion. Whereas Alt-Scherbitz embodied rustic asymmetry, Austrian villa asylums, particularly those in which Wagner or one of his students was involved, exemplified rational modularity. Indeed, Steinhof owes its striking appearance to the fanatical symmetry that Wagner imposed on the site. What began as a loosely symmetrical plan accommodating the natural variations of the hillside became, in Wagner’s hands, a rigid arrangement that called for expensive terracing. Seen today, Steinhof presents as the apotheosis of order. Thus the visual vocabulary of liberty deployed at Alt-Scherbitz gave way to a modernist vocabulary of order and efficiency. Rather than mimicking domesticity, Austrian villa asylums projected a planned monumentality. Steinhof in particular looks as though it were built to awe its patients into compliance.

The villa asylum may indeed have been the right response to Austria’s “nervous age.”5 It removed patients from their surroundings and let them recuperate, not unlike the popular spas and sanatoriums of the time. But it also subjected them to two crucial tools of modern social control: surveillance and planning. Those committed at Steinhof found themselves sorted according to the severity of their illnesses and subjected to varying degrees of control organized by the environment around them. We see a variant on this principle today in the design of hospital intensive-care units, where glass is a prominent feature of the interior-facing sides of patient rooms. Large windows and wide glass doors allow medical staff to monitor patients at a glance, surveilling in the service of a cure.

Crowned by its church, Steinhof’s white walls and imposing facades evoke a modernist city on a hill: rational and ordered, but also bright and healthy. The innovations made here—attention to light and air, provision of outdoor spaces, multiple units instead of one monolithic structure—would even reappear in the great public-housing projects that became Austria’s next social experiment, offering a socialist utopia to match the medical one. These tiny cities for the insane are early experiments in the architecture of medicine and social control. Rather than chaining the mentally ill to their bedposts, Austria’s psychiatrists tried to persuade them that the asylum hardly confined them. And its architects—in their own way—obliged.

  1. Part of this growth reflects the incorporation of Vienna’s existing suburbs into the city itself, but it was in the suburbs that many of the era’s immigrants settled.

  2. Robert Wegs, Growing Up Working Class: Continuity and Change Among Viennese Youth, 1890–1938 (Penn State University Press, 1989), p. 19.

  3. Otto Wagner, Modern Architecture (1896), as cited in Carl Schorske, Fin-de-siècle Vienna (Cambridge University Press, 1981), p. 74.

  4. Wagner’s design can be seen in Carl Schorske, Fin-de-siècle Vienna, pp. 99–100.

  5. These are the words of Richard von Krafft-Ebing, the preeminent psychiatrist of the day, as given in his work Über gesunde und kranke Nerven (H. Laupp’sche, 1885), p. 1.