'Architecture Of An Asylum' Tracks History Of U.S. Treatment Of Mental Illness

Jul 6, 2017
Originally published on July 6, 2017 11:54 am

When I moved to Washington, D.C., in 1962, St. Elizabeths Hospital was notorious — a rundown federal facility for the treatment of people with mental illness that was overcrowded and understaffed. Opened with idealism and hope in 1855, the facility had ballooned from 250 patients to as many as 8,000. Its vast, rolling patch of farmland had fallen into disrepair, too, in the poorest neighborhood in the U.S. capital.

St. Elizabeths is now the subject of an exhibition at the National Building Museum; Architecture of an Asylum explores the links between architecture and mental health.

Dorothea Dix, the 19th-century reformer who fought for the facility, would have rolled over in her grave to see what St. Elizabeths had become by the 1960s.

"She had observed the treatment of the mentally ill in jails and other kinds of alms houses [and] poor houses all over the country," explains exhibit curator Sarah Leavitt. Dix "was really appalled by the treatment that they were getting, and she made it her life's work to change that story."

Dix lobbied state legislators and Congress and got them to create what was then called The Government Hospital for the Insane. She hand-picked the land on which it was built. And at her small wooden desk — you can see it in the exhibition — Dix outlined her vision.

"She really believed that architecture and landscape architecture would really have a role in curing people," Leavitt says.

Denise Everson, an architect in the D.C. area who specializes in design and health, says certain elements were considered vital: Natural light and views of the outdoors were thought to help keep patients from feeling "hemmed in," Everson explains. "So that you know you are a part of a larger society."

Dix insisted on these elements for her hospital. Leavitt says disgust with the dark cells, barred windows and bone-chilling cold in 19th century jails likely fueled Dix's thinking.

"There was this idea that the mentally ill wouldn't notice extreme cold or heat," Leavitt says. "She was really disgusted by that, and really viscerally angry."

Dix made sure the hospital that became St. Elizabeths in 1916 had heat, tall arched windows and screened sleeping porches where patients could catch summer breezes. Photos, models and floor plans included in the museum exhibit show handsome brick buildings — with towers, high ceilings, open space and river views.

In the 1850s, these facilities were available only to white patients, though. African-American patients were housed in two smaller buildings, without the same amenities and views. Women and men — white or black — were also separated. Still, 100 years before psychiatric drugs, everyone got the same treatment.

St. Elizabeths gave some mentally ill patients hydrotherapy — baths, showers and wraps.

"There was the hot water to calm more manic patients," Leavitt says, "and the cold water to stimulate quieter patients that needed to get awake." Photos show patients lying wrapped like mummies in wet blankets.

Another picture, from the 1920s, shows a man sitting at an electroshock machine, a lamplike device suspended over his head. A few lobotomies were performed at the hospital as well. "The idea was that it would calm the patient, which probably it did, but at what cost?" Leavitt says.

The historic photos reveal some happier moments, too — one from the 1960s shows dance therapist Marian Chace moving around a room with patients.

"She really believed that would help open up their minds, and help them come to peace with their day, with their existence — with everything," Leavitt says. "I think that's a really beautiful image."

But, over decades, the sun-filled, airy rooms of St. Elizabeths got overcrowded, understaffed and eventually emptied out. New psychiatric drug therapies, decreased federal and state support, and the de-institutionalization of many patients — which started with President John F. Kennedy and increased under Ronald Reagan — led to a societal shift toward community-based treatment. It's an approach that has helped some but left others struggling with their condition in homeless shelters, on the streets or in jails.

There are still 300 patients at St. Elizabeths, but 75 buildings stand idle. The graceful St. Elizabeths campus will eventually house condos and the Department of Homeland Security.

Still, Dix's dream of architecture as a path to healing lives on.

"Some things cannot be cured," says Everson. "But I think humane treatment — I think, creative treatment — is where we should go as a community, as a nation and as a world."

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RACHEL MARTIN, HOST:

Ezra Pound, a major American poet, and John Hinckley Jr., the man who shot President Reagan - both men had something in common - St. Elizabeths Hospital, where those with mental illness were housed. NPR special correspondent Susan Stamberg says a new exhibit at the National Building Museum explores the links between architecture and mental health.

SUSAN STAMBERG, BYLINE: When I moved to Washington in 1962, St. Elizabeths was notorious. A federal facility opened with idealism and hope in 1855, had ballooned from 250 patients to 8,000. Its vast, rolling patch of farmland had become the poorest neighborhood in the capital. Dorothea Dix, the 19th-century reformer, who fought for the hospital, would have rolled over in her grave.

SARAH LEAVITT: She had observed the treatment of the mentally ill in jails and other kinds of alms houses, poor houses all over the country...

STAMBERG: Sarah Leavitt is curator of the St. Elizabeths exhibit.

LEAVITT: ...And was really appalled by the treatment that they were getting. And she made it her life's work to change that story.

STAMBERG: She crusaded state legislators and the Congress and got them to create what was then called the Government Hospital for the Insane. She handpicked land on which it was to be built. And at her small, wooden desk - it's in the exhibition - Dorothea Dix outlined her vision.

LEAVITT: She really believed that architecture and landscape architecture would really have a role in curing people.

STAMBERG: R. Denise Everson, an architect who specializes in design and health, says certain elements are vital.

R. DENISE EVERSON: ...Natural light, views of the outdoors so you don't feel hemmed in, so that you know that you are part of a larger society.

STAMBERG: Dix insisted on these elements for the Government Hospital for the Insane. Curator Leavitt says the dark cells, the bars, the cold she'd seen in jails fueled Dix's thinking.

LEAVITT: There was this idea that they mentally ill wouldn't notice extreme cold or heat. And she was really disgusted by that and really viscerally angry.

STAMBERG: Dix made sure the hospital that became St. Elizabeths in 1916 had heat and tall, arched windows so light could stream in and screened sleeping porches, where patients could catch summer breezes. Photos, floor plans and models in the exhibit show handsome brick buildings with towers, high ceilings, open space and river views available in the 1850s only to certain patients.

LEAVITT: The African-American patients were in these two little buildings here, behind the building. They did not have those views.

STAMBERG: Women and men, white or black, were separated, too. But a hundred years before mood drugs, everyone got the same treatment. St. Elizabeths gave mentally ill patients hydrotherapy.

LEAVITT: There was the hot water, which would calm more manic patients, and then the cold water to stimulate patients that were quieter or needed to get awake.

STAMBERG: Photos show them after the baths, lying wrapped like mummies in wet blankets. Another picture from the 1920s shows a man sitting at an electroshock machine. A lamp-like device is suspended over his head.

LEAVITT: And then it would come down onto his head. And the shocks would come through the machine. You can see it's connected by a wire.

STAMBERG: A few lobotomies were also performed at St. E's, a portion of the brain removed.

LEAVITT: The idea was that it would calm the patient, which probably it did - but at what cost to the patient?

STAMBERG: Far less chilling, a photo from the 1960s of dance therapist Marian Chase, moving around a room with patients.

LEAVITT: She really believed that would help open up their minds and help them come to peace with their day or with their existence, with everything. And I think that's a really beautiful image. Just the look on her face of kind of pure joy and dance is something I really appreciate.

STAMBERG: Over decades, the sun-filled, airy rooms of St. Elizabeths got overcrowded, understaffed and eventually, emptied out. There are still 300 patients there. But 75 buildings stand idle. New drug therapies, less federal and state support and deinstitutionalization, which started with President Kennedy and increased under Reagan, put many of today's mentally ill into homeless shelters or on the streets or in jail.

The graceful St. Elizabeths campus will eventually house condos and the Department of Homeland Security. But Dorothea Dix's dream of architecture as a path toward helping the mentally ill lives on in the hearts of many, including building and health architect R. Denise Everson.

EVERSON: I don't know about cure. Some things cannot be cured. But I think humane treatment, I think creative treatment, is where we should go as a community, as a nation and as a world.

STAMBERG: "Architecture Of An Asylum: St. Elizabeths" is at the National Building Museum until January. In Washington, I'm Susan Stamberg. Transcript provided by NPR, Copyright NPR.