Leslie Topp's Freedom and the Cage explores seven public psychiatric institutions built between 1898 and 1914 in the late Habsburg Empire, the Austro-Hungarian territories whose major cities included Prague, Vienna, and Kraków. The central idea of the book is that each of these hospitals offered a degree of freedom within a highly controlled environment. Such freedom of movement made the psychiatric hospital seem more “normal.” This paradoxical notion—that one could move about in a seemingly normal way even though confined—comes from Michel Foucault's influential work on the asylum in History of Madness.1 Topp warns that for architectural historians who work on institutions, “there is no escaping Foucault” (13), and thus her six-chapter, generously illustrated book also serves as an example of how to use the French philosopher's work as a historical source rather than as a theory to be wholly accepted or rejected.

The seven hospitals at the center of Topp's book range in scale from 350 to 2,200 beds and extend in location from Kraków to Trieste. They exemplify the so-called villa system, a progressive arrangement developed in Germany that overtook the more oppressive corridor or “closed” system of design for mental hospitals by about 1900. A corridor-system hospital was a large, monolithic structure with repetitive floor plans featuring large wards and ubiquitous corridors. Patients were literally enclosed in one building, which gave the impression of a prison because of this containment. In the late nineteenth century, Topp explains, a group of psychiatrists pushed for a more enlightened system based on separate villas, which would offer the appearance of an urban district or a neighborhood within the institution. The new type of hospital featured smaller, freestanding “houses” distributed over massive sites, and thus it prescribed more movement, both indoors and outdoors. Not surprisingly, the architects of villa-system hospitals engaged the principles of urban planning, as the spaces between the separate pavilions—pathways, exterior grounds, and walls—became significant aspects of the healing institution. The villa system also meant that pavilions could be custom-designed to accommodate particular patient groups, from highly restrictive to unrestrictive. Topp notes in her first chapter that the hospital Alt-Scherbitz, outside Leipzig, Germany, and a detailed publication by its director, Albrecht Paetz, were particularly influential for the Habsburg institutions showcased in the book. Paetz believed that even the sight of walls, locks, and bars was detrimental for patients and that the illusion of free movement was a powerful healing tool in psychiatry.

By far my favorite two chapters of Topp's book are those titled “Spaces” and “Boundaries,” chapters 5 and 6, respectively. While the first four chapters take on thematic issues illustrated by one or two of the seven case studies, the tone and rhythm of the book changes in this superb double act that analyzes them all at once. In “Spaces,” Topp examines the spatial codes of the Habsburg asylums by looking closely at the plans. She takes readers on a tour through corridors and cells, arguing convincingly that the image of confinement in the corridor-system hospitals was as dependent on the arrangement of these elements as it was on walls, locks, and bars. The climax of chapter 5 is Topp's revelation that the plan for Otto Wagner's Lower Austrian Provincial Institution for the Care and Cure of Mental and Nervous Disorders, or “am Steinhof,” in Vienna, which opened in 1907, is the most conservative in the group, featuring the problematic corridor from days gone by and a grid-like site plan that meant pavilions were seen as undifferentiated. Among the case studies Topp presents, the Steinhof psychiatric hospital is likely the one best known to readers, given its famous architect and the predominance of its domed church.

In “Boundaries,” Topp turns to the surroundings of the Habsburg hospitals. She notes that asylum architects carefully placed walls, fences, and hedges so that they would appear “natural,” in the same ways the interiors of the pavilions were meant to simulate “normal” spaces like private homes. And it was the outer boundaries of asylums, she argues, that made them coherent. I particularly like the section in this chapter on boarding out, where Topp bravely looks beyond the actual walls of the hospitals as a way to understand the sheer power of institutional boundaries in this precarious dance of containment and movement. “The progressive asylum was a kind of living exhibition of how the most unstable members of modern society could be established, the uprooted rerooted, so that they could be trusted with freedom,” she states (186).

Freedom and the Cage contributes enormously to the literature on hospital architecture produced in the past twenty-five years, complementing excellent work by scholars such as Thomas Markus, Christine Stevenson, Jeremy Taylor, and Carla Yanni, with whom Topp explicitly engages in her book. Most obviously, Topp covers a geographical area and a range of primary sources not previously covered by English-speaking scholars. Like Markus's Buildings and Power (1993), Topp's book tackles the relationship between power and the plan. Like Stevenson's Medicine and Magnificence (2000), it shows that hospital design was often counterintuitive: If fresh air was key to healing, as miasmatists believed, why did it make sense to contain the sick in an inward-turning building? As Taylor does in his work on the pavilion-plan hospital typology, The Architect and the Pavilion Hospital (1997), Topp posits hospitals “in conversation,” viewing each of the seven institutions she discusses as a different position on the challenge of designing a cage that appears to support free movement.2 “I have seen these plans not as mute technical diagrams to be deciphered by the architectural historian but rather as positions in a debate,” she says (157). Carla Yanni's 2007 book The Architecture of Madness, on American asylums, shares with Freedom and the Cage a deep understanding of how psychiatry and architecture were entwined in this period.3 Unmentioned by Topp but significant in this literature is Jeanne Kisacky's Rise of the Modern Hospital, also published in 2017, making this a banner year for the architectural history of hospitals.4 

Additionally, Freedom and the Cage serves as an excellent model for research on institutions beyond hospitals, such as schools, prisons, convents, summer camps, day-care centers, dormitories, long-term residential care facilities, and any other typologies that comprise multiple buildings and complex, mixed functions designed to keep people in. The book's lessons come from broad and clear arguments about institutional design: that building design is often a critique of past buildings, propelling the evolution of the building type; that specialized buildings often work in conversation with each other, almost as if they were participating in an architectural debate; that architecture holds tremendous power in setting the “impression” of how a place works, even from the curb or from the air; and, perhaps most important, that institutional architecture controls its users but not its historians.


Michel Foucault, History of Madness, ed. Jean Khalfa, trans. Jonathan Murphy and Jean Khalfa (London: Routledge, 2006); originally published as Folie et déraison: Histoire de la folie à l’âge classique (Paris: Librairie Plon, 1961).
Thomas A. Markus, Buildings and Power: Freedom and Control in the Origin of Modern Building Types (London: Routledge, 1993); Christine Stevenson, Medicine and Magnificence: British Hospital and Asylum Architecture, 1660–1815 (New Haven, Conn.: Yale University Press, 2000); Jeremy Taylor, The Architect and the Pavilion Hospital: Dialogue and Design Creativity in England, 1850–1914 (London: Leicester University Press, 1997).
Carla Yanni, The Architecture of Madness: Insane Asylums in the United States (Minneapolis: University of Minnesota Press, 2007).
Jeanne Kisacky, Rise of the Modern Hospital: An Architectural History of Health and Healing, 1870–1940 (Pittsburgh: University of Pittsburgh Press, 2017).