Department Chair

Andrew D. Nicholls, Ph.D.

Date of Award


Access Control

Open Access

Degree Name

History, M.A.


History and Social Studies Education Department


Andrew Nicholls

Department Home page

Andrew Nicholls

First Reader

Andrew Nicholls

Second Reader

Noelle Wiedemer


During the 19th and 20th centuries, the mental health care system in the United States underwent a series of reforms in an effort to better care for some of the country’s frailest citizens. This period, called the moral hygiene era of mental health care, emerged from a further understanding of psychiatry and psychology which led to structural changes in the mental health care system.

This thesis examines the beginnings of the Kirkbride system, which sought to reform the whole of American mental health care through landscaping and architecture as well as the specific treatment plan for each individual. Using case studies like the Buffalo State Hospital demonstrates how Dr. Thomas Kirkbride’s ideas filtered throughout the country. Adding to Kirkbride’s ideas, reformer Dorothea Dix also promoted humane treatment for the mentally ill. Unfortunately, with the onset of the Industrial Revolution and ideas about scientific management and eugenics Dix and Kirkbride’s ideas faded. It took reformers like stunt reporter Nellie Bly to reenergize those earlier ideas. But most professionals squabbled amongst themselves instead of making real progress. World War I served as a catalyst for a reset in how practitioners approached mental health care. By the 1920s, new practitioners like Mary Cromwell Jarrett took the ideas of Kirkbride and Dix and created psychiatric social work. An assessment of these reformers shows that their plans for a modern mental health care system are still relevant in twenty-first-century society.