One of the most iconic gothic asylums of all time, the Hudson River Asylum for the Insane broke ground in 1866. The County of Dutchess NY and City of Poughkeepsie NY offered a 208-acre farm plot within close proximity of the Hudson River. $100,000 was given for the construction of the famous Kirkbride building. The Kirkbride was designed by Frederick Clarke Withers. It was the first institutional classified building in the US to be built using the High Victorian Gothic architecture style. The asylum opened its doors to patients in 1871 and only 7 were admitted during that year. By the following year, the hospital had accommodations to house 212 patients and had spent $1,000,000.

Through the rest of the 1800's, the hospital saw numerous expansions and additional buildings. By the year 1908, the hospital had a 2,708-bed capacity and spanned across 1000 acres. Most notable was the large expansion made to the north wing of the Kirkbride building, making it much larger than the other wing. At this time a typical staff was 20 doctors along with 608 other employees working within the hospital. The different buildings and different wings of the Kirkbride allowed patients to be separated by tubercular, epileptic, general, and violent/dangerous.

The 20th century brought even more expansion and new buildings at the hospital. By 1952, the patient population was over 6,000. This was short lived due to the advance of modern medicine in the 1970's. Fewer patients needed to be admitted to a long-term psychiatric hospital. In the late 1970's, two wings of the Kirkbride building were decommissioned due to the low patient population and infrastructure problems. The hospital was designated as a