St. Elizabeths Hospital

During the 1840s and 50s, Dorothea Lynde Dix petitioned across America to improve conditions for those deemed insane. In 1852, she brought her campaign to Washington, and it was decided that Congress would provide $100,000 to establish the first federally run psychiatric hospital in the United States.


Dix and the first Superintendent, Dr. Charles Nichols chose a beautifully serene location for the new asylum, based around the philosophy of care known as ‘Moral Treatment.’ The peaceful setting was situated outside of the city on a large hill overlooking the Anacostia River, affording idyllic views and plentiful space for outdoor activity. In addition, the site was ideal for providing the hospital with vital resources, such as water, building materials and fuel, allowing it become predominantly self-sufficient.

The U.S Government Hospital for the Insane opened its doors in 1855 with the mission statement to ‘provide the most humane care and enlightened curative treatment.’ The Center Building was the first structure to be built on site, and was designed by Superintendent Nichols and Thomas U. Walter and primarily based on the Kirkbride Plan. This created a long building with multiple sections staggered en echelon, which in turn provided patients with fresh air, light and privacy.

St Elizabeths

Many materials used in building the hospital were harvested on site, such as the clay used for bricks and the interior woodwork from the surrounding forestry. Each ward had woodwork created from a different species of tree, such as the ‘Cherry Ward’ and the ‘Beech Ward.’ Other buildings on site included the East and West Lodges for the African-American patients, Gatehouse 1, a farmer’s cottage, stables, a gardener’s dormitory, a machine shop and a laundry. A brick and stone wall surrounded the complex, alongside campus roads and walkways that still exist today. 

The Missing Apostrophe

During the Civil War(1861-1865), the asylum was temporarily converted into a hospital for wounded soldiers, dealing primarily with amputees. Soldiers were reluctant to tell their families they were residing in the U.S Government Hospital for the insane, and instead gave them the name of the land patent on which hospital was located; St Elizabeths. This became a well-known nickname for the hospital until 1916, when Congress changed the hospital’s name officially. The original seventeenth-century name was kept in tact, hence the lack of apostrophe in ‘Elizabeths’.

Military Asylum


By the late 1860s, the hospital had already reached its capacity, forcing Congress to purchase additional land and construct new buildings. Shepard Farm (now known as the East campus) was bought in 1869, to contribute to the hospital’s self-sufficiency, and the ‘Moral Treatment’ philosophy. It was situated across the road from the original site, and many patients participated in the preparation of the land for farm usage. By 1874, over 50 acres of land had been levelled, drained and fertilized, predominantly by St Elizabeths patients as a part of their occupational therapy.

Several constructions were funded for the agricultural programme, including a stock and hay barn, grazing sheds, greenhouses, a piggery, a hay barrack, a windmill, and a tool and poultry house. When in operation, the farm provided a stable food supply, consisting of milk, beef, asparagus, rhubarb, radishes, tomatoes, potatoes, cucumbers, corn, watermelons, cabbages and small fruits such as strawberries.

Additional support buildings were built from 1870 and consisted of a fire house, a patient dining hall, kitchens, a mortuary, and a bakery. 

Superintendent William W. Godding

Dr William W. Godding replaced Dr Charles Nichols in 1877, and he called for further expansion immediately. The patient population of over 700 was three times higher than the recommended figure, and over-crowding was becoming a severe issue. ‘Moral Treatment’ focused on open spaces, privacy and relaxation, yet under such cramped conditions, it was virtually impossible to continue with the philosophy.

As a consequence, a further 21 buildings were constructed during Godding’s tenure, each of them focusing on the basic principles of ‘Moral Treatment’ as opposed to simply increasing capacity. This meant that the new patient buildings were small, cottage-like stuctures which added a homely atmosphere which the patients could feel comfortable in. It also gave Godding the opportunity to house patients according to the severity of their illness, so those who needed extra care could be identified and heavily supervised. Howard Hall was a separate house, which was surrounded by a security fence and was specifically for those deemed criminally insane.

St Elizabeths Howard Hall

Whilst agriculture was still a crucial aspect in the daily operations of St Elizabeths, Godding began to take a great interest in the West Campus landscape. Large pieces of land were transformed into pleasure gardens, complete with water features, benches, pavilions and bridges. A selection of exotic trees were planted throughout the western campus by the son of the superintendent, Alvah Godding whom had grown up on the hospital grounds. 

Superintendents Alonzo B.Richardson and William Alanson White

By 1900, over-crowding had once again become a monumental problem in St Elizabeths, and both Superintendents Alonzo B.Richardson and William Alanson White were forced to further expand the hospital grounds. The farm which provided the hospital with both food and money was transformed into the East Campus, complete with a range of patient care buildings. Richardson petitioned against this, arguing that the road in between the two campuses was a danger to both staff and patients, but he was over-ruled after a year of debating. The farm was relocated to a 400 acre piece of land at the mouth of Oxon Creek soon after.

The planning for the third expansion took place whilst Richardson was Superintendent, but the construction began under Superintendent White in 1903. A total of nine buildings for patient care were constructed, alongside a range of administrative offices which were placed around the central lawn. A further four patient care buildings were added to the East Campus, connected to the main buildings by an underground tunnel. 

Superintendent List

Charles Henry Nichols 1852 – 1877
William Whitney Godding 1877 – 1899
Alonzo Blair Richardson 1899 – 1903
William Alanson White 1903 – 1937
Roscoe W. Hall (acting) 1937 – 1937
Winfred Overholser 1937 – 1962
Dale C. Cameron 1962 – 1967
David W. Harris (acting) 1967 – 1968
Louis Jacobs 1968 – 1969
Luther Robinson (acting) 1969 – 1972
Luther Robinson 1972 – 1975
Roger Peele (acting) 1975 – 1977
Charles Meredith 1977 – 1979
William H. Dobbs (acting) 1979 – 1981
William H. Dobbs 1981 – 1984
William G. Prescott 1984 – 1987 

The Decline

The end of World War II also saw the end of the agricultural programme at St Elizabeths. The dairy barns and the farm staff housing were demolished, and the livestock were disposed of. It was the official end of the hospital’s self-sufficiency and its ‘Moral Treatment’ philosophy. By the 1950s, large institutions were becoming increasingly outdated, and considered to be a hindrance upon the treatment and well being of the patients. Community-based care was quickly replacing the larger institutions, and the population of St Elizabeths plummeted steadily for several decades.

St Elizabeths was designated as a National Historic Landmark in 1990, and by 1996, only 850 patients resided at the hospital. The building was in a clear state of disrepair; the heating system was unreliable, leaving patients in the cold for weeks at a time, and medicine shortages occurred so frequently that treatment was becoming impossible. In 2002, the remaining patients on the West Campus were relocated to other mental health facilities, leaving just over 400 patients in total. 

Notable Patients

Mary Claire Fuller – An actress and screenwriter who was committed to St Elizabeths in 1947 when she had a breakdown after the death of her Mother. She spent 25 years in the hospital.

James Swann – Also known as “The Shotgun Stalker,” Swann was an American serial killer who was notorious for his drive-by shotgun shootings in Washington DC in 1993. He was found not guilty by reason of insanity and sent to reside at St Elizabeths.

Ezra Pound – A famous American poet and critic of the modernist movement, Pound moved to Italy after World War I, and was eventually hired by the Italian government to make hundred of radio broadcasts criticising the U.S.

Ezra Pound

He was arrested by US forces in 1945 for treason, and sent to a U.S military camp in Pisa where he suffered a mental breakdown. Deemed as unfit to stand trial, he was sent to St Elizabeths where he spent twelve years incarcerated.

Dr. William Chester Minor – An Army surgeon, Minor began spending most of his free time visiting prostitutes. Unsatisfied with his behaviour, the army sent him to a remote part of Northwest Florida in the hopes of a behavioural improvement. His mental health deteriorated, until he was finally sent to St Elizabeths in 1868. Several years later, he went on to shoot a man and spend time in Broadmoor Hospital.

Richard Lawrence – Attempted to assassinate President Andrew Jackson in 1835. He was found not guilty by reason of insanity and sent to St Elizabeths, where he remained until his death in 1861.

John Hinckley Jr – Attempted to assassinate President Ronald Regan in 1981 in a disillusioned attempt to impress his idol, Jodie Foster. He was found not guilty by reason of insanity and sent to St Elizabeths where he claimed he would: “see a therapist, answer mail, play guitar, listen to music, play pool, watch television, eat lousy food and take delicious medication.”

Charles Julius Guiteau – A preacher and writer, Guiteau shot President James Garfield to his death in 1881. Due to disillusioned behaviour, he spent time at St Elizabeths, where he was analysed by Superintendent Godding. Godding declared him insane, and not fit to stand trial, but his decision was over-ruled and Guiteau was found guilty and hanged the following year.

Hosptal Attributes

St Elizabeths Hospital played an integral role in developing high standards of care for state asylums in the U.S. As the first Federal asylum, it led the way for others to follow suit in terms of design and treatment. The early years of treatment focused on ‘Moral Treatment’ and providing the best possible conditions for the mentally ill. The hospital served as a fine example of the conditions Dorethea Dix was campaigning for. The pastoral environment was an enlightened change from the previous dismal harsh treatments dealt to the mentally ill before Dix’s campaign in the 1840s.

St Elizabeths Allison Dormitory

‘Moral Therapy’ was eventually phased out of St Elizabeths, to make room for a scientific approach. In 1881, on his way to give a speech in Washington, President James Garfield was assassinated. His killer was Charles Guiteau, a disillusioned preacher, who believed he would be acquitted of his crime and become the replacement President. Superintendent Godding of St Elizabeths analysed the mental state of Guiteau, and found him to be insane and incompetent to stand trial. Despite his findings, the assassin was found guilty and was later hanged for his crime. An autopsy was performed, and abnormalities were found in Guiteau’s brain which indicated that Superintendent Godding was correct in his analysis. Shortly afterwards, St Elizabeths was granted a pathology laboratory, and leading pathologist Dr Blackburn joined the hospital staff.

St Elizabeths Autopsy Theater

This was the first time in history that a state mental hospital had hired a pathologist, and it singled out St Elizabeths once again as a pioneering institution. During his 27 year tenure at the hospital, Dr Blackburn performed over two thousand autopsies, and created a complex anthology of notes and diagrams of his findings. These papers have proven to be a crucial contribution to the field of pathology, and became invaluable in the scientific industry. Alongside building a pathology lab, St Elizabeths was one of the first federally ran hospital to make provisions for African-American patients, to use Hydrotherapy as part of a treatment plan, create a psychotherapy department and to run a nursing school from 1894.

Father of the prefrontal leucotomy, Walter Freeman,served in St Elizabeths for several years as the medical director of the Research Laboratories, until in 1924 he left to focus his work entirely on his leucotomy plans.

During the World War II, CIA’s predecessor, the Office of Strategic Services, used the facilities at St Elizabeths to test their ‘Truth Serums’. A cocktail of Mescaline and Scopolamine was used on a number of volunteers, along side tests with THC (the psychoactive ingredient in Cannabis), all of which resulted in failure. 


St Elizabeths is often looked back as being a leading US mental hospital, leading the way for others of its kind to follow suit. Many treatments such as the lobotomy and hydrotherapy began within the hospital walls, and scientific barriers were shattered as continual progress was made. However, many experts and former patients declare that this is a romantic ideal of how St Elizabeths operated, and ‘pioneering treatments’ which were performed.

St Elizabeths treatment

St Elizabeths has a long history of over-crowding. Although many expansions were added to the original grounds to combat this, thousands of patients suffered. At numerous intervals during St Elizabeths’ history, there were too many patients to be supervised and cared for by the over-ran staff. During these times, early treatments such as ‘Moral Therapy’ dwindled, and the notions of resting in pastoral care became a distant memory.

Throughout the years, St Elizabeths was on the forefront of medical experiences and treatments, most of which were often crude and barbaric by today’s standards. Hydrotherapy, Insulin Shock Therapy, Electroshock Therapy and Lobotomies were all tried, tested and performed at St Elizabeths, causing irreparable damage to countless patients. 

Present day

In 2002, all remaining patients on the West Campus were transferred to other institutions, and the hospital continues to operate on a much smaller scale. A civil and forensic (criminal) hospital was built on the East Campus in the spring of 2010, and was designed to combine the majority of the remaining patients into one, state-of-the-art building.

St Elizabeths New

This building holds enclosed courtyards, a library, an auditorium, computer laboratories, and a museum and has a capacity limit of 300 patients.

  • Saint Elizabeths Hospital and the US Department of Justice Settlement Agreement

           *According to the District of Columbia Department of Behavioural Health

Following a review of Saint Elizabeths Hospital in 2005, from January to June, the District Government and the Department of Justice on June 25, 2007 signed a Settlement Agreement that outlines how the District will address alleged deficiencies without acknowledging liability and sets a time frame for completing the changes. In October 2011, the District and the Department of Justice entered into a modified Agreement which suspended monitoring on approximately 115 requirements due to sustained compliance by the Hospital. The modified Agreement also extended its term through September 30, 2012, with a subsequent year of continued monitoring.
To see a copy of the Settlement Agreement, please visit our Document Vault

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