Our Research Notes series invites authors to describe their process for a recent book, with “research” defined as broadly as they like. This week, Stephanie Carpenter writes about Moral Treatment, inaugural winner of the Summit Series Prize from Central Michigan University Press.

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My research for my debut novel, Moral Treatment, began when I was a kid, exploring the park-like grounds of the Traverse City State Hospital. A sprawling, residential psychiatric facility on the west side of my hometown, the hospital opened in 1885 and closed in 1989, during a nationwide trend toward deinstitutionalization. Adjacent to the modern medical hospital and across the road from my junior high school, the State Hospital was vast, accessible, and irresistible. As teenagers, we’d dodge security guards in their tell-tale green pick-up trucks. The hospital’s oldest buildings—Victorian, vandalized, long-abandoned—called to us to sneak inside.

I never managed that trespass, though I know plenty of people who did. Instead, I eventually found another way in. At the hospital’s small, short-lived museum, I’d learned about odd cases and early therapeutic tools, and I’d heard fragmented stories of older relatives’ experiences, working at the hospital. (To my knowledge, no one in my family was ever treated there). But, as I grew up, I wanted to know more about the hospital’s origin story: why had such an enormous facility been built in our remote corner of Michigan? What needs did it serve? When I decided to write about the hospital—my first attempt at historical fiction—those questions were my starting point.

In the local history collection of my hometown’s public library, I learned how civic leaders in the 1880s had pitched Traverse City as the location for what was then called the Northern Michigan Asylum. The third such facility in the state—more would soon follow—it was intended to serve all of northern lower Michigan and the Upper Peninsula, consolidating and improving care for people experiencing mental illness…and, records suggest, for people experiencing a host of other medical and personal struggles. The hospital’s construction and staffing needs were a huge economic boon to the area. 

Learning that the hospital’s original building was a “Kirkbride Hospital” led me to Thomas Story Kirkbride’s 1854 text, On the Construction, Organization, and General Arrangements of Hospitals for the Insane. Kirkbride was a Quaker, reformer, and long-time superintendent of the Pennsylvania Hospital for the Insane; his book offers detailed instructions for hospital management, ranging from what to pay attendants to the proper ventilation of urinals. On the Construction… revealed the logic of the Traverse City hospital’s original building, a sprawling linear structure whose wings stretch nearly a quarter mile. Following Kirkbride’s architectural plan, doctors lived in apartments at the center, with women’s wards to the north and men’s to the south. The farther you moved from the center and the higher you went through the wards, the more severe the patients’ illnesses became. I ate up old and new photos of TCSH’s interior spaces.

I learned that the Kirkbride plan was a key component of the moral treatment, the system that gives my novel its title. Moral treatment sought to replace inhumane methods of care with compassionate ones. Patients were removed from the “aggravating causes” of their illnesses and placed in comfortable surroundings with good food, positive influences, and ready medical attention. Kirkbride hospitals were sanitary and modern—Traverse City patients were the first people in the area to use electric lights—and featured attractive grounds, occupational therapies, and evening entertainments. Restraints and other punitive measures were mostly abolished; morphine was among the few drugs used. As the emphasis on architecture suggests, orderliness and routine were important tenets of the treatment.

But as I continued reading—from secondary texts and rich primary sources like The American Journal of Insanity, a trade journal for asylum superintendents—I learned that by the late nineteenth century, a new architectural approach dominated mental health care. The “pavilion plan” featured cottage-like, homey buildings, less imposing and easier to supervise than Kirkbride buildings. Thus, when it opened in 1885, the Traverse City hospital was already out of date by some professional standards. Why? When building a state-of-the-art medical facility at enormous cost, why follow an architectural plan criticized as inefficient and unmanageable? 

One of my novel’s protagonists grew out of that question. I didn’t want to write about the actual historical doctors who’d founded my hometown hospital—that felt presumptuous, as well as limiting. So I translated the problem of the hospital being always already outmoded into the character of the hospital’s aging superintendent. To convey his deep identification with his work, I refer to him only as “the doctor.” The doctor is well-intentioned and highly principled, but resistant to criticism of the moral treatment, especially when he sees risky and cruel alternatives emerging in its wake. He believes that if he could more perfectly execute Kirkbride’s plan, he could improve his hospital’s low cure rate—a belief that’s exhausting him and frustrating his wife and colleagues. 

It would have been appropriative—and nearly impossible, under Michigan’s patient confidentiality laws—for me to write about actual individuals who were treated at the hospital in the 1880s. Instead, my other protagonist, a newly-admitted teenaged woman named Amy Underwood, is inspired by ambiguities I saw in nineteenth-century diagnostic criteria, especially for illnesses associated with women. According to the paradigms of the period, Amy suffers from “pubescent insanity”: acute neurosis, intellectual derangement, delusions brought on by puberty. As Amy adjusts to life at the hospital, the relationships she forms give a sense of the eclectic reasons women were institutionalized in this period, and the ways that issues of class and gender impacted their care and their options, outside of the hospital. 

Naturally, the hospital’s architecture plays a crucial role in my novel. With a few small exceptions, the entire story takes place on the hospital grounds. I wanted the characters to confront and resolve their conflicts within the system, if they could. What does it mean to live in this place and its routines? And what does it mean to leave?

Today, the once-crumbling hospital that inspired Moral Treatment is a thriving mixed-use development, a transformation that began as I was starting my formal research. Condos carved out of Traverse City’s Kirkbride building now sell for half a million dollars or more; shops and restaurants sit in its cellar; trails crisscross the wooded hills that rise behind the hospital’s campus. I’m glad that the place has a new life and a clear future, and I still love spending time there—though without the illicit thrill of sneaking around vacant buildings. With my novel, I try to honor those who didn’t have the freedom to come and go as they pleased.

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Stephanie Carpenter’s debut novel, Moral Treatment, is the inaugural winner of the Summit Series Prize from Central Michigan University Press and is forthcoming in February 2025. She’s the author of Missing Persons: Stories, which won the 2017 Press 53 Award in Short Fiction; her work has also appeared in journals including Copper Nickel, Ecotone, The Missouri Review, Big Fiction, and Witness. Stephanie holds an MFA in Creative Writing from Syracuse University and a PhD in Literature and Creative Writing from the University of Missouri. She’s an Assistant Professor of Creative Writing at Michigan Technological University. Find her online at stephanie-carpenter.com, Instagram, and Facebook.