The buildings that make up the sprawling campus of St. Elizabeths psychiatric hospital in Southeast — much of which has gone unused for decades and is in varying stages of disrepair — stands as a kind of reminder of how the mentally ill have been treated in the U.S. over the past 165 years.

The story of the devolution of St. Elizabeths st e 3is told in the National Building Museum’s Architecture of an Asylum exhibit, which includes photos, architectural drawings and such artifacts as a box that housed brain tissue samples and a patient bill of rights.

Originally the Government Hospital for the Insane, the inauspicious name was later changed to the more palatable St. Elizabeths. (Although like New York’s Bellevue Hospital, the innocuous-sounding moniker has done little to mask the institutions’ missions.)

St. Elizabeths main building, constructed in 1852, was designed to provide patients with copious light and fresh air — believed at the time to aid in the convalescence of mental illness. In the 1870s, the hospital’s new director ordered Victorian cottages to be built to house the residents because he felt the main building manifested a prison-like atmosphere. Conventional wisdom of the time dictated that patients would be better served by smaller, homier residences than large, institutional quarters. This idea proved impractical, as caring for patients spread throughout a number of buildings was time-consuming and inefficient.

Today, the main building’s façade still stands, but the inside is gutted. Plans to preserve the exterior hit a snag when its structural integrity was called into question.

At the time the hospital was constructed, it was not unusual for the mentally ill to be warehoused together with criminals, the elderly and homeless people, as if they had anything in common other than their apparently inconvenient existence.

Activist for the mentally ill Dorothea Dix, who expressed outrage and consternation at the living conditions of those unfortunate enough to be confined to the horrific quarters common at the time, was instrumental in the development of St. Elizabeths. She campaigned tirelessly for a D.C. facility to take the burden off the only local hospital at the time in Baltimore, where conditions were overcrowded and unsanitary.

Patient care at the new St. Elizabeths would be shocking by today’s standards, but was a vast improvement over typical mental hospital conditions. Some patients were forced to dig clay that was used to make bricks for new buildings on the campus — but only patients from “the laboring class” were selected for this task. Other were given jobs on hospital farms or gardens, with the idea that work might help set them free. These pursuits were indeed improvements from the days in which patients were not allowed to move about freely and even physically restrained.

Over the years, St. Elizabeths patients were treated with the most modern techniques available, including psychotherapy, hydrotherapy, electroshock therapy and pharmaceuticals. Despite these efforts, many patients lived most of their adult lives at St. Elizabeths and ultimately died there, never having shown any improvement.


Many of the original buildings have been demolished or fallen into disrepair. Today, St. Elizabeths functions as a much smaller facility serving up to 280 patients in a building constructed in 2010. Several of the old, remaining buildings have been earmarked to be repurposed to house the Department of Homeland Security.

Architecture of an Asylum, through Jan. 15, National Building Museum, 401 F St. NW; Hours, Monday – Saturday 10 a.m. – 5 p.m., Sunday 11 a.m. – 5 p.m.


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