View of Washington from St. Elizabeths, 1955. A distant view of the downtown D.C. maintained separation between the hospital grounds and the bustle and stress of the city.
View of Washington from St. Elizabeths, 1955. A distant view of the downtown D.C. maintained separation between the hospital grounds and the bustle and stress of the city. Credit: Courtesy U.S. National Library of Medicine

It’s hard to imagine anyone dealt a worse hand than the patient identified by her doctor as “Alcoholic Woman No. 2.” Her father died in a mental hospital when she was an infant. Her mother was psychotic, “fanatically religious,” and abusive, according to a medical case study. Woman No. 2 spent most of her childhood in an orphanage. Her husband divorced her because of her drinking. She racked up 15 arrests and two suicide attempts before being committed to St. Elizabeths, the federal asylum in D.C., sometime in the mid-1900s.

This unfortunate woman was one of the many thousands of Americans to receive treatment at St. Elizabeths over its 162 years and counting as a mental hospital. These patients are ghostly presences in Architecture of an Asylum, a new exhibition at the National Building Museum.

Like the outermost figure in a Russian nesting doll, the story of this one institution holds within it a series of resonant narratives: about shifting attitudes toward mental illness; about the idea that architecture and landscape can heal the troubled; and about a part of the District that was long cut off from the rest of the city, becoming its own surprisingly complex and self-sufficient community.  

Originally named the Government Hospital for the Insane, and now being turned into the U.S. Department of Homeland Security headquarters (on the west side) and a mixed-use development (on the east), St. Elizabeths opened in 1855. Dorothea Dix, an activist for the welfare of the mentally ill, advocated for its founding, and the desk at which she drafted the 1852 federal legislation that enabled the hospital is part of the exhibition. She went on to advise on the design and operations of the facility. Its architect, Thomas U. Walter, was designing the cast-iron dome for the U.S. Capitol at the same time that he was working on St. Elizabeths.

Walter had previously designed a prison and a home for orphans, in line with that era’s strong interest in using architecture as a tool for social reform. Before the advent of germ theory and modern psychiatry, experts believed the underlying causes of what made people sick or maladjusted were found in their environments. So it followed that a better environment would mold healthier citizens.

That was the philosophy of Thomas Kirkbride, a Pennsylvania doctor specializing in mental disorders. He argued that mental hospitals should all be based on the same general plan. Long wings, staggered for maximum exposure to fresh air and sunlight, would flank a central administrative building. The most severely disturbed patients would stay at the ends of the wings, farthest from the superintendent.

Walter’s central building, the first structure at St. Elizabeths, followed the Kirkbride Plan. But the model soon fell out of favor, and subsequent patient housing on the campus took the form of cottages, thought to offer more of a home-like atmosphere. With an expansion in 1902, the buildings became statelier, reflecting “the idea that [provision for the mentally ill] is an important function of the federal government,” says Sarah Leavitt, the exhibition’s curator.

As the facilities changed, so did the regimens for treating mental ailments. Initially, the so-called “moral treatment” prevailed. Attendants were to offer patients sympathetic care plus a daily routine with plenty of time outdoors—gazing on the pleasant vista of Washington and doing manual labor. Hydrotherapy was also standard: hot water for insomniacs, cool water to put out the fires of mania. As medical science advanced, the hospital became a research center and testing ground for new treatments, some of them controversial. Doctors performed lobotomies and administered electroshock therapy.

The racial segregation that defined the outside world was the rule on the hospital’s grounds as well. Until the 1950s, African Americans were housed in separate buildings and ate in separate dining rooms. All attendants were white until 1937, as were all doctors until 1954. White male doctors had first dibs on delivering the most promising, cutting-edge treatments, which were sometimes not offered to women and nonwhite patients until years later.

Walls and fences surrounded the hospital to keep the patients in, but also to keep outsiders out (early on, locals would sneak in to steal produce from the farms). St. Elizabeths was a mysterious place that most Washingtonians never visited. But behind the walls, it was a bustling city-within-a-city. The photographs and artifacts in the exhibit make you marvel at the scope of the hospital’s activities.

At its peak, St. Elizabeths had a population of 14,000 patients and staff on its campus of 350 acres—three times the size of Vatican City. It had its own dedicated rail spur from the B&O line for bringing in coal. Patients wrote poems for an intra-hospital newsletter, visited an on-site hair salon, and took part in dance therapy sessions and baseball games. The exhibition portrays St. Elizabeths as a real community and its patients as real people with lives beyond their diagnoses.

One topic the show keeps fairly quiet about, however, is patient abuse. Allegations of abuse have been lodged against St. Elizabeths’ staff ever since the hospital opened, as one wall placard notes. The fact that hundreds of patients likely suffered at the hands of those charged with helping them hangs uneasily in the air. In the 1990s, as was detailed in the press, patients were sometimes put in restraints for weeks and seclusion rooms for days, and the FBI investigated claims of physical abuse by staff. As recently as last October, City Paper reported on 632 assaults and 384 injuries in a single year at the facility, which is now run by the District and has dwindled to some 300 patients.

Kirkbride’s belief that the right kind of building could cure mental illness may seem like folly in the age of Prozac. But the link between environment and health hasn’t been disproven—far from it. Recent research has backed up some of Kirkbride’s and Dix’s principles. Hospital patients in rooms with a view of nature recover more quickly. Exercise and daylight have been shown to improve people’s moods. Where Kirkbride and his peers erred was in thinking that environmental conditions alone were enough to cure illness, not in thinking that they mattered—because they do.

By the mid-20th century, America’s mental hospitals were stretched far beyond their capacity, causing conditions to deteriorate. In 1963, President John F. Kennedy called for the closure of large institutions, to be replaced by some 1,500 community mental-health clinics. The first part of his plan, deinstitutionalization, came to pass. The second part didn’t.

The result: There are now three times as many mentally ill people in jails and prisons as there are in hospitals. What have we really learned in the past 162 years?

“America designed and built the greatest infrastructure in the history of the world for some of the most vulnerable of its citizens,” Leavitt says, “and then we destroyed it.” If you believe in the forward march of progress, Architecture of an Asylum may make you reconsider—another reason to head to the Building Museum for this illuminating show.