The Asylum

Mental institutions are an icon in Western fiction, and they’ve seeped into our consciousness as gamers. But are we adequately prepared to use them well in games? Institutions as a game element are a combination of individual components: architecture, history, conditions, and context/use.

Kirkbride Buildings

It’s likely the photos of abandoned asylums you’ve seen in the States are in fact one of these buildings. Dr. Thomas Story Kirkbride, a superintendent for an asylum wrote multiple papers on the influence of hospital design on treatment and recovery. These papers would have an incredible reach of influence on asylum construction. The fanning outward wings are a ‘batwing’ design, and a key feature of a Kirkbride Building. Kirkbride Buildings were not seen by Dr. Kirkbride as where you put patients, but as one of the strongest tools to facilitate patient recovery. One of the most easily accessible Kirkbride websites discussing their current condition and history can be found here.

Kirkbride Plan

Plate No. 1 and No. 2 from Thomas Story Kirkbride’s On the Construction, Organization, and General Arrangements of Hospitals for the Insane. From “On the Construction, Organization, and General Arrangements of Hospitals for the Insane,” Thomas Kirkbride.

Some Asylum History

If you’re using an institution in the United States, historic or imaginary, there’s tons of  information out there for you. If you’re running a game pre-1900, or using historic records from the period, I’d recommend Ten Days in a Mad-House by Nellie Bly as a resource. You can even read it online, and follow reporter Nellie Bly’s expose of the Women’s Asylum on Blackwell’s Island. When this report was published in 1887, the City of New York would respond by earmarking a sizable amount of funding to improve conditions at the asylum. It’s a good read if you have characters infiltrating an institution, and some of the general attitudes and conditions can be ported to present day. A quick walk through your library stacks or Amazon can turn up a plethora books, ranging from academic tomes to pop histories of the asylums we have trusted to treat and heal our loved ones. Discovery Channel also has an illustrated mini-history of asylums.


The problems people discuss about mental institutions have always been present. Poor funding, lack of adequate care, patient abuse, forcible treatments, experimentation. The two that persist the most in the modern era (though the others still persist) are poor funding, and a lack of adequate care. I was having a drink with a mental health professional last year, and they informed me people in that area shouldn’t be afraid of calling a crisis line and getting taken for an involuntary psychiatric evolution.

“We can’t take them for a long-term, involuntary commitment to a facility. We don’t have the money to hold them.”

Under-funded and under-staffed in many places, the remaining large asylums still in operation walk a razor thin edge to stay in operation. There are only so many beds in a facility, so institutions operate in a constant state of triage. If you’re looking for the present day conditions of abandoned institutions, checking out the websites of experienced urban explorers is an excellent start. If you want to know more about present-day conditions of mental institutions, be aware that conditions in say, Italy, will be very different from conditions and current policies in the States. If you want detail heavy reading material on present day conditions, look for psychiatric journals. If you want a less intense read on current conditions, newspapers, magazines and some science bloggers will frequently cover mental healthcare, including residential programs.


Mental healthcare has a lot attached to it, good or bad, in our shared cultural mind. Staying consciously aware of that, ask yourself why the asylum is a necessary location. What do you or the players have potential to add to the game by using this facility in a session? Whether the gameplay around it is intense or not, are you adding to the fun at the table? I consider the use of asylums in my own games as mature subject matter. I’m conscious that makes my approach to game facilitation one that’s often very serious, which is not everyone’s style. And that is totally cool. With potent touchstones, like asylums and mental health, I tend towards cautious. That’s because many people have personal experiences with those topics. When you choose any location or theme, think of it like writing. What potential does this addition to the session have to bring about maximum fun, thrills, character progression, plot advancement?

If you want to drop an asylum in because “it’s spooky,” you may want to consider creepy scares from other building types. If you need the players to be emotionally devastated by their empathy and compassion for the suffering others, while trying to achieve their goals, then the asylum’s a sound choice for characters to face their prejudices and deepest fears.

Been present for a session where an asylum was used well? Know some great history resources for people who want to use them in games? Leave your stories and suggestions in the comments.


About l

L is a freelancer currently working as a writer, editor, journalist and game designer. She hauls a suitcase decorated in stickers as she blogs, travels, and tours. She makes her home in Washington, California, and wherever the tour stopped last night. You can follow L on twitter (@lilyorit )

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