Originally built in 1797 far from Baltimore, the Spring Grove Hospital Center is now consumed by the expanding University of Maryland, Baltimore County, campus in Catonsville. On a recent Baltimore Heritage tour, I was struck by the hospital’s architecture—old and new mixtures of brick, stone, glass, and cement, both stately and nondescript. Written across these buildings was more than 200 years of psychiatric care. But when we learned that the hospital’s current baseball field was built on a patient graveyard, I remembered the tragic irony of asylum history: it was exactly the stories I was being told—about dilapidated buildings where people experienced neglect and horror—that the 18th- and 19th-century inventors of the modern asylum had tried to vanquish.

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By the 18th century, the European concept of asylum captured a type of sanctuary for those like the mentally ill, lepers, and the elderly poor, who were especially vulnerable to mistreatment. As 18th-century philosophes began to debate a new idea called “human rights,” distaste grew for inhumane treatment and environments for the mentally ill. Reformers in England and France pushed for grand experiments in care, including “moral treatment,” a therapeutic approach with bucolic, structured environments where patients could learn how to manage and recover from their conditions. By the early 1810s, word had reached the United States that sympathetic and scientific treatment of mentally ill patients could restore the faculties, defying centuries of belief in the immutability of mental illness.

By 1861, mental hospitals expanded across the United States, even in the South, where enslaved people built institutions to which they could not be admitted. The Kirkbride Plan became the standard for asylum architecture. Its palatial image—an enormous V-shaped building with two wings, stone columns, brick facade, grand entryway, and large common rooms—communicated the asylum’s permanence and authority. In accordance with moral treatment, Kirkbride institutions were built far from the stress and sound of cities, surrounded by orchards, gardens, and farms where no more than 150 patients performed the labors designed to make both the institution and the soul self-sustaining.

Mental trauma follows war, and established mental hospitals strained under the skyrocketing numbers of patients after the Civil War. Shell-shocked veterans and Southern African Americans, no longer legally prohibited from care, filtered into already overcrowded asylums. Postwar economic devastation and market crashes created mental health crises and strained hospital budgets. Moral treatment was prohibitively expensive and unceremoniously abandoned. States expanded institutions rapidly—and poorly—to meet carceral demands, housing thousands of patients on campuses designed to hold a fraction of that number. Death, disease, tragedy, scandal, and rumor persisted around mental health institutions. By 1900, the curative aims of the mental institution were a pipe dream; the mental hospital’s reputation, permanently sullied. As new construction designed to meet the needs of states rather than patients supplanted the old, the old became too expensive to maintain. The asylums of the 19th century eroded into ruins.

Many of these sites have been demolished, but the grand and gothic ruins of asylums still haunt the American landscape and our psyches. Whether in horror movies or ghost-hunting reality shows, they evoke a past where people were institutionalized against their will, separated from their families, and buried in careless graves. But asylum ruins house another poltergeist. For a moment, the wills of state governments, reformers, and doctors aligned to create a state institution that could not only rehabilitate the mentally ill but also reimagine the responsibility of a state to its people. To accurately remember the tragedy of the asylum, we must add political failure to the retinue of ghosts walking the floors between crumbling brick walls.