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| Photo by Adam Johnson |
Stephanie Carpenter is the author of the new novel Moral Treatment. She also has written the story collection Missing Persons, and she is an assistant professor of creative writing at Michigan Technological University.
Q: What inspired you to write Moral Treatment, and how did you create your character Amy?
A: The novel grew out of my interest in the Traverse City State Hospital, a sprawling psychiatric hospital in my hometown in northern Michigan. When I was a kid, some of the newest buildings on the hospital’s large campus still were in use, but by 1989, the entire facility had been decommissioned.
As a teenager, I spent a lot of time on the hospital’s grounds. I was never lucky or bold enough to find a way inside the empty buildings, but I know a lot of people who did. The hospital’s oldest buildings—vast, Victorian, vacant—always fascinated me.
Among other things, I was curious about why such a huge hospital had been built in our relatively small town.
Researching the hospital’s origin story, I learned about the “moral treatment” that took hold in the US in the early 19th century and the Kirkbride architectural plan that grew out of it. The moral treatment approached mental illnesses as medical disorders and replaced earlier, punitive methods of treatment with humane care.
The Kirkbride plan for residential hospitals was devised in the 1850s by Thomas Story Kirkbride, superintendent of the Pennsylvania Hospital for the Insane. It’s a large, linear building, with administrative offices and housing for the medical team at its center, and two long, stepped patient wings, segregated by sex and by the severity of patients’ illnesses.
Kirkbride’s 1854 On the Construction, Organization, and General Arrangements of Hospitals for the Insane details every aspect of such a hospital, and the plan was widely adopted.
I appreciated the progressive sentiments behind these reforms, but it also was clear to me that these hospitals were, as Michel Foucault contends, institutions of discipline and control. The moral treatment sought to conform people to an idea of normalcy, to submit them to their doctors’ authority—a goal that’s paternalistic and potentially abusive.
With my novel, I wanted to capture this complexity, exploring the gap between a dedicated practitioner’s idea of the hospital and a patient’s experience.
Moral Treatment is told in alternating sections from the third-person perspectives of the hospital’s founding superintendent, a man in his mid-60s who I refer to as “the doctor,” to reflect the depth of his commitment to his profession, and a newly-admitted 17-year-old woman, Amy Underwood.
I originally imagined Amy as a character who was distressed by her father’s work in the logging industry. In early drafts, witnessing deforestation was the “probable exciting cause” of her illness.
In the final version of the novel, Amy still feels a strong connection to trees, but her diagnosis is “pubescent insanity,” a condition defined so broadly that I felt almost anyone could relate to it. (That said, this isn’t a baseless diagnosis: the events that lead to Amy’s hospitalization deeply frighten her parents and convince them that they can’t care for her safely at home).
As a newcomer to the hospital and a patient, Amy sees the place very differently than the doctor does. She’s trying to make sense not only of the doctor’s system, but also of the daily dynamics on the ward and of her own state of mind and being.
Q: Can you say more about how you researched the novel, and did you learn anything that especially surprised you?
A: I read a lot of primary source materials, including issues of The American Journal of Insanity, a trade publication for the Association of Medical Superintendents of American Institutions for the Insane; annual reports from the Northern Michigan Asylum (the original name of the Traverse City hospital); 19th-century medical texts; historical newspapers; and of course Kirkbride’s book.
Patient accounts were harder to come by, but sources like Elizabeth Packard’s Modern Persecution, or, Insane Asylums Unveiled (1874) and Nelly Bly’s Ten Days in a Mad-House (1887) were very helpful. I also drew from many wonderful secondary sources, including Nancy Tomes’s The Art of Asylum-Keeping and Ellen Dwyer’s Homes for the Mad.
The biggest surprise in my research—and the spark for the character of the doctor—was that the hospital that inspired my novel was, in the view of some contemporaries, always out of date. By the time the Northern Michigan Asylum was built in the 1880s, the Kirkbride Plan was widely criticized as inefficient, ineffective, and stigmatizing.
These hospitals were also typically overcrowded and understaffed, since the “cure” rate achieved by the moral treatment was quite low—and the presence of one of these hospitals in a community tended to broaden the public’s definitions of “insanity.” Meanwhile, the homier “cottage plan” was gaining in popularity as a more sustainable and less imposing alternative.
The Traverse City hospital was enormously expensive to build and included every modern convenience—so why wouldn’t it follow the most up-to-date architectural plan?
My doctor grew out of that question. He’s stalwartly committed to the moral treatment, believing that its successes should not be measured only in “cures,” but also by the protections it offers to vulnerable and marginalized people.
He’s rightly concerned about the potential for patient abuse in emerging approaches to care, but he’s exhausting himself trying to oversee everything about this enormous hospital whose therapeutic properties are lessened with every new person it admits. He’s stuck.
Q: The writer Eric Torgersen called the book “as relevant today as in the 19th century.” What do you think of that assessment?
A: In context, Eric was referring to some of the dynamics of the novel: “Troubled young girls… families and adult ‘institutions’ too often powerless to save them—these are as relevant today as in the 19th century of Stephanie Carpenter’s clear-eyed yet compassionate novel.”
I agree that generational disconnects are an evergreen problem. In my novel, Amy’s father and stepmother can only understand Amy’s erratic behavior through their own frames of reference, which include the death by suicide of Amy’s mother.
They catastrophize, because they love Amy but they’re failing to connect with or help her. They’ve tried everything else; having her admitted to the hospital seems like their last, best hope.
At the hospital, Amy is a case, monitored daily by the doctors, but in some ways, she has more space to be herself and to observe what’s happening around her, thinking about where she fits, who she wants to be.
Q: What do you hope readers take away from the book?
A: I hope readers appreciate that the power struggles taking place in the novel are being conducted on uneven terrain, and that the women characters—whether by asserting their own religious authority, advocating for social reforms, accusing the doctors of misconduct, or simply running away—never stop fighting to be seen and heard.
I also hope that the doctor’s predicament resonates. I’ve always been intrigued by smart, well-meaning people who can’t or won’t give up flawed endeavors. The doctor is doing some good, but those around him are aware—and maybe he knows, too—that by being open to other ideas and possibilities, he could be more.
Q: What are you working on now?
A: I’m working on revisions to a completed manuscript, Many and Wide Separations: Two Novellas. Like Moral Treatment, the novellas are literary historical fictions; they’re set in Massachusetts in the mid-19th century and are linked by their interest in visual art and women’s empowerment. I have an agent for the book and it will go out on submission sometime in 2025.
I’m also at work on a very different project: an eco-gothic, post-apocalyptic novella that imagines what nature gods might emerge from a landscape ravaged by climate change.
Q: Anything else we should know?
A: Moral Treatment is the inaugural winner of the Summit Series Prize from Central Michigan University Press. The press plans to publish one title a year; their 2025 contest closed on January 1 and will publish a poetry collection with a Michigan connection.
I’m thrilled that Moral Treatment has received favorable advance reviews, and I hope readers will connect with it, too! You can find me online at stephanie-carpenter.com; Instagram.com/scarpent9; or Facebook.com/stephanie.carpenter.author.
--Interview with Deborah Kalb
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