An exhibit at the National Building Museum reveals some of the history of St. Elizabeths Hospital in southeast D.C. while exploring changes in mental health care over the years.
St. Elizabeths was built in 1855 and opened as the Government Hospital for the Insane. Back then, mental illness was a complete mystery. The first attempts to diagnose what we now call schizophrenia were still half a century away.
Treatment was a mystery, too. Discovery of the first psychiatric medication, Thorazine, wouldn't happen for another century.
Congress authorized construction of St. Es as part of a national movement to treat people with mental illness in a humane manner and a setting that offered connection to nature, and hopefully, a path to wellness.
"So St. Es, when it was built, it was really kind of a model for psych hospitals at the time, but they weren't called that though,” curator Sarah Leavitt said. "They were usually called insane asylums, and St. Es was one of about 80 that were built in the same style in the late 1800s and St. Es was the federal hospital while the rest were all the state level."
St. Es was a huge source of pride for the people who created it. The setting offers one of the most beautiful views of the city. Its windows had grates instead of bars.
”The idea again that this wasn't a prison,” Leavitt said. “It was supposed to have decorative qualities for the patients."
But the view and the hospital experience were not the same for all patients.
"From the very beginning, St Es was segregated for its first 100 years in the wards, in the activities, in dining halls, and you can see evidence of that,” Leavitt said. “African-American patients would have been in completely separate buildings at St. Es.”
For many years, all the treatments were experimental, and some of them were inhumane by modern standards. Lobotomies were an infrequent and desperate attempt to cure the most difficult cases. In hydrotherapy, patients were wrapped up like wet mummies.
There are records of about 18,000 autopsies performed at St. Elizabeths as researchers tried to understand the biology of mental illness and make progress in understanding Alzheimer’s and other disorders. That practice stopped years ago.
St. Elizabeths started with about 250 patient beds and was soon overcrowded with civil war casualties. The place expanded many times over the years. At its peak in the early 1960s there were almost 100 buildings on the campus, housing almost 8,000 patients, who were still segregated.
"And then you start seeing deinstitutionalization where patients start being moved out of large, custodial hospitals into the 1980s, where they start losing the federal funding for those hospitals almost completely,” Leavitt said. “There’s still a couple thousand patients at the turn of the 21st century, and that goes down and down as patients are moved into other types of care -- outpatient care, foster homes, other types of elderly care facilities.”
Many of those who would be patients under the old system now live in prisons and on the streets. Today St. Elizabeths still cares for about 250 patients, in a hospital built in 2010 and now run by the city.
George Washington University School of Medicine psychology teacher Dr. Amir Afkhami hopes his students visit the National Building Museum exhibit and consider the future.
“We still have a long way to go in understanding a variety of mental illness," Afkahmi. “We need to have very serious conversations about how we are going to address this crisis, how we're going to address the crisis of mental illness as it relates to our criminal justice system. How are we going to address mental illness as it relates to homelessness or the issue of overusage of medical resources."
The St. Elizabeths campus is shrinking as the city prepares for lots of new development on some prime real estate.