St. Elizabeths Hospital

For the facility in Boston formerly known as St. Elizabeth's Hospital, see St. Elizabeth's Medical Center (Boston).

St. Elizabeths Hospital
U.S. National Register of Historic Places
U.S. National Historic Landmark
The Center Building at St. Elizabeths in 2006
Location	2700 and 2701 Martin Luther King, Jr., Avenue, 1100 Alabama Avenue SE Washington, D.C.
Coordinates	38°51′03″N 76°59′40″W
Area	346 acres (140 ha)
Built	1852
Architect	Thomas U. Walter; Shepley, Rutan and Coolidge
Architectural style	Italianate Revival, Italian Gothic Revival
NRHP reference No.	79003101
Significant dates
Added to NRHP	April 26, 1979
Designated NHL	December 14, 1990

St. Elizabeths Hospital opened in 1855 as the first federally operated psychiatric hospital in the United States. Housing over 8,000 patients at its peak in the 1950s, the hospital at one point had a fully functioning medical-surgical unit, a school of nursing, and accredited internships and psychiatric residencies. Its campus was designated a National Historic Landmark in 1990.

St. Elizabeths is in southeast Washington, D.C.. Since 2010, hospital functions have been limited to a portion of the east campus operated by the District of Columbia Department of Mental Health. The remainder of the east campus is slated for redevelopment by the District of Columbia which owns the site. The west campus is owned by the federal government and is being redeveloped for use as headquarters for the U.S. Department of Homeland Security and its child agencies.

History

Early years and peak operations

The Center Building at St. Elizabeths, one of the oldest on the campus, as it appeared in the early 20th Century

The hospital was created in August 1852 when the United States Congress appropriated $100,000 for the construction of a mental hospital in Washington, D.C.; to provide care for indigent, mentally ill residents of the District of Columbia, as well as for the insane of the U.S. Army and U.S. Navy. As early as the 1830s, local residents including Dr. Thomas Miller, a local doctor and president of the D.C. Board of Health, had been petitioning Congress for a facility to care for the mentally ill in the City of Washington. Their efforts were given a significant boost when Dorothea Dix (1802-1877), a pioneering advocate for people living with mental illnesses, helped convince legislators of the need for the hospital. In 1852 she wrote the legislation that established the hospital. Dix, who was on friendly terms with President Millard Fillmore, was asked to assist the Secretary of the Interior in getting the hospital started. Her first recommendation resulted in the appointment of Dr. Charles H. Nichols as the hospital's first superintendent. After his appointment in the fall of 1852, Nichols and Dix began formulating a plan for the design and operation of the hospital as well as finding an appropriate location for it, based upon guidelines created by Thomas Story Kirkbride. His 1854 manual recommended specifics such as site, ventilation, number of patients and the need for a rural location proximate to a city. He also recommended that the location have good soil for farming and gardens for the patients.

Dr. Nichols oversaw the design and building of St. Elizabeths which began in 1853. It was built in three phases, the west wing first, then the east wing and finally the center portion. The center portion was built to house all administrative operations as well as the superintendents' residential quarters. All three sections of the hospital were together under one roof, in keeping with Kirkbride's design. Two other buildings, the West Lodge (1856-1898) for men and the East Lodge for women were built to house and care for African American patients.

Soon after the hospital opened to patients in January 1855, it became known officially as the Government Hospital for the Insane. During the Civil War the West Lodge, originally built for male African-American patients, was used as a general hospital by the U.S. Navy. The unfinished east wing of the main building was used by the U.S. Army as a general hospital for sick and wounded soldiers. The Army hospital officially took the name of St. Elizabeths Army Medical Hospital to differentiate it from the mental hospital in the west wing of the same building. The name St. Elizabeths was derived from the colonial-era name for the tract of land on which the hospital was built.

After the Civil War and the closing of the Army's hospital, the St. Elizabeths name was used unofficially and intermittently until 1916, when Congress passed legislation changing the name from the Government Hospital for the Insane to St. Elizabeths Hospital, inexplicably omitting the possessive apostrophe.

In the late 19th century, the hospital temporarily housed animals which were brought back from expeditions for the Smithsonian Institution, because of lack of housing for the animals at the yet to be built National Zoo.

At its peak, the St. Elizabeths campus housed 8,000 patients and employed 4,000 people. Beginning in the 1950s, however, large institutions such as St. Elizabeths were being criticized for hindering the treatment of patients. Community-based health care, as specified in the passage of the 1963 Community Mental Health Act, led to deinstitutionalization. The act provided for local outpatient facilities and drug therapy as a more effective means of allowing patients to live near-normal lives. The first community-based center for mental health was established at St. Elizabeths in 1969. The patient population of St. Elizabeths steadily declined.

Later years

The Main Building on the western campus at St. Elizabeths

By 1996, only 850 patients remained at the hospital, and years of neglect had become apparent; equipment and medicine shortages occurred frequently, and the heating system was broken for weeks at a time. By 2002, all remaining patients on the Federal western campus were transferred to other facilities. Although it continues to operate, it does so on a far smaller scale than it once did. As of January 31, 2009, the current patient census was 404 in-patients.

In recent years, approximately half of St. Elizabeths patients are civilly committed to the hospital for treatment; the other half are forensic (criminal) patients. Forensic patients are those who are adjudicated to be criminally insane (not guilty by reason of insanity) or considered incompetent to stand trial. Civil patients are those who are admitted due to an acute need for psychiatric care. Civil patients can be voluntarily or involuntarily committed for treatment.

A new civil and forensic hospital was built on the East Campus by the District of Columbia Department of Mental Health and opened in the spring of 2010, housing approximately 297 patients. Until the new hospital opened, civil patients were cared for in various buildings on the East Campus; forensic patients were housed in the John Howard Pavilion. In the new facility, civil and forensic patients live in separate units of the same building. The new hospital also houses a library, an auditorium, multiple computer laboratories, and a small museum in the lobby.

In 2007, the U.S. Department of Justice and the District of Columbia reached a settlement over allegations that the civil rights of patients housed at St. Elizabeths were violated by the District. On August 28, 2014, the Department of Justice found that St. Elizabeths had "significantly improved the care and treatment of persons confined to Saint Elizabeths Hospital" and asked a federal court to dismiss the injunction. In January 2015, DC Auditors dismissed the settlement agreement and officially ended oversight of St. Elizabeths Hospital.

Revitalization plans for western campus

Atkins Hall, home to U.S. Coast Guard Historian's Office in 2014

See also: Douglas A. Munro Coast Guard Headquarters Building

After several decades in decline, the large campus could not be maintained. In 1987, hospital functions on the eastern campus were transferred from the United States Department of Health and Human Services to the District of Columbia government, with the federal government retaining ownership of the western campus. Several commercial redevelopment opportunities were proposed by the D.C. government and consultants, including relocating the University of the District of Columbia to the campus or developing office and retail space. However, the tremendous cost of bringing the facilities up to code (estimated at $50–$100 million) kept developers away.

With little interest in developing the site privately, the Federal Government stepped in. Control of the western campus—home of the oldest building on the campus, the Center Building—was transferred to the General Services Administration in 2004. GSA improved security around the campus, shored up roofs, and covered the windows with plywood in an attempt to preserve the campus until a tenant could be found.

After three years of searching for an occupant, the Department of Homeland Security (DHS) announced on March 20, 2007 that it would spend approximately US$4.1 billion to move its headquarters and most of its Washington-based offices to a new 4,500,000-square-foot (420,000 m²) facility on the site, beginning with the United States Coast Guard in 2010. DHS, whose operations are scattered around dozens of buildings in the Washington, D.C. area, hopes to consolidate at least 60 of its facilities at St. Elizabeths and to save $64 million per year in rental costs. DHS also hopes to improve employee morale and unity by having a central location from which to operate.

The view of the Washington, D.C. skyline from St. Elizabeths

The plans to locate DHS to St. Elizabeths have been met with criticism, however. Historic preservationists argue that the move will destroy dozens of historic buildings located on the campus and that other alternatives should be considered. Community activists have also expressed concern that the planned high-security facility will not interact with the surrounding community and do little to revitalize the economically depressed area. In 2007, the District of Columbia reached a deal with the Department of Justice and agreed to fix widespread health and safety hazards in the hospital.

A ceremonial groundbreaking for the DHS consolidated headquarters took place at St. Elizabeths on September 11, 2009. The event was attended by Senator Joseph Lieberman, DHS Secretary Janet Napolitano, DC Delegate Eleanor Holmes Norton, DC Mayor Adrian Fenty, and acting GSA Administrator Paul Prouty.

The relocated U.S. Coast Guard Headquarters Building was forecast to open in May 2013, and a ceremony was held in July 2013 at the site before it is to be officially opened. Along U.S. Coast Guard Headquarters Building, several former hospital buildings (Atkins Hall, cafeteria) had been rehabilitated.

Patients

Well-known patients of St. Elizabeths have included would-be Presidential assassins Richard Lawrence (who attempted to kill Andrew Jackson) and John Hinckley, Jr., who shot Ronald Reagan, as well as the assassin of James Garfield, Charles J. Guiteau (until his execution). Other notable residents were Mary Fuller, James Swann, Ezra Pound, and William Chester Minor.

According to Kelly Patricia O'Meara, St. Elizabeths is believed to have treated over 125,000 patients, though an exact number is not known due to poor record keeping. Additionally, she believes that thousands of patients are buried in unmarked graves across the campus, although records for the individuals buried in the graves have been lost. She believes that the incinerator on site also brings up a few questions as to what may have happened to the bodies. The General Services Administration, current owner of the property, considered using ground penetrating radar to attempt to locate unmarked graves but has yet to do so.

More than 15,000 known autopsies were performed at St. Elizabeths between 1884 and 1982, and a collection of over 1,400 brains preserved in formaldehyde, 5,000 photographs of brains, and 100,000 slides of brain tissue was maintained by the hospital; until the collection was transferred to a museum in 1986, according to O'Meara. In addition to the mental health patients buried on the campus, several hundred American Civil War soldiers are interred at St. Elizabeths as well.

Contributions to medicine

An elderly patient at St. Elizabeths, ca. 1917

Several important therapeutic techniques were pioneered at St. Elizabeths, and it served as a model for later institutions. Walter Freeman, onetime laboratory director, was inspired by St. Elizabeths to pioneer the transorbital lobotomy. During American involvement in World War II, the Office of Strategic Services (OSS, predecessor to the CIA) used facilities and staff at St. Elizabeths hospital to test "truth serums". OSS unsuccessfully tested a mescaline and scopolamine cocktail as a truth drug on two volunteers at St. Elizabeths Hospital. Separate tests of THC as a truth serum were equally unsuccessful. In 1963 Dr. Luther D. Robinson, the first African-American superintendent of St. Elizabeths, founded the mental health program for the deaf and was throughout his career a leading authority on treating deaf patients with mental disorders.

Facilities and grounds

The campus of St. Elizabeths sits on bluffs overlooking the confluence of the Potomac and Anacostia Rivers in the southeast quadrant of Washington, D.C. It is divided by Martin Luther King, Jr. Avenue between the 118-acre (48 ha) east campus (owned by the D.C. Government) and the 182-acre (74 ha) west campus (owned by the Federal Government). It has many important buildings, foremost among them the Center Building, designed according to the principles of the Kirkbride Plan by Thomas U. Walter (1804–1887), who is better known as the primary architect of the expansion of the U.S. Capitol that was begun in 1851.

Much of St. Elizabeths' campus has now fallen into disuse and is in serious disrepair. It has been named one of the nation's 11 Most Endangered Places in 2002 by the National Trust for Historic Preservation. Access to many areas of the campus, including the abandoned western campus (which houses the Center Building) is restricted.

In popular culture

• The hospital was referred to in an episode of the television series Bonanza. The episode was "The Unseen Wound", featuring Leslie Nielsen as a sheriff, playing a former Civil-War-era Army officer who falls victim to PTSD, although the modern term was not used in the script.
• In the TV series The Rebel episode "Berserk", a PTSD victim was told by Nick Adams' character at the end of the show as he climbed aboard a stagecoach that he's 'headed to a new hospital in Washington called St. Elizabeth's'.
• Portions of the west campus can be seen in the film A Few Good Men.
• National Public Radio interns toured the east and west campuses, then shared their experiences, in 2010.
• St. Elizabeths is referenced several times in W.E.B. Griffin's The Corps Series and Men at War as a place that the Office of Strategic Services (OSS) will confine people they consider a security risk for the duration of World War II.
• Abraham Lincoln mentioned St. Elizabeths to Mary Todd Lincoln in the novel Mrs. Lincoln's Dressmaker by Jennifer Chiaverini. It is shown to her because she cannot control her grief over the death of her son Willie.
• Wizards practice facility and Mystics home court will be on the site of the old St. E's hospital.

Further reading

• Otto, Thomas. St. Elizabeths: A History. U.S. General Services Administration. 2013
• Streatfeild, D. Brainwash. St. Martin's Press. 2007.

External links

• St. Elizabeth's Hospital East Campus Redevelopment
• St. Elizabeth's Hospital Facebook Page
• Listing at the National Park Service
• Kirkbride Buildings
• GSA Development of St. Elizabeths Campus
• Historic American Landscapes Survey (HALS) No. DC-11, "St. Elizabeths Hospital West Campus"
• U.S. Geological Survey Geographic Names Information System: Saint Elizabeths Hospital