[Introduction]
[The Civil War Years]
[Railroads]
[Not Wedded To Any System]
[New Methods Adopted]
Introduction The old and new are combined
at Saint Elizabeths Hospital, where for more than one hundred years a Federal
hospital devoted entirely to the care of the mentally ill has been graving in
size, in curative skills, and in training and research activities. Ground was
broken for the first building in 1852, and the first patients were admitted in
1855. In the century since then, more than 125 buildings have been built among
the forest trees that cover the 320 rolling acres on a promontory where the
Potomac and Anacostia Rivers meet, and in these buildings many new methods of
treatment have been initiated and adopted. The Hospital has not always been
known as Saint Elizabeths. In the 1840's and 1850's, when Dorothea Lynda Dix
was crusading on behalf of the mentally ill and establishing hospitals in
various localities both here and abroad, she literally badgered the United
States Congress into making an appropriation for a "Government Hospital
for the Insane," "...the object of which was to give the most humane
care and enlightened curative treatment of the insane...." Land known as
"the Saint Elizabeths tract" was selected for the Government
hospital. The first building, now called Center Building, was designed over a
modified "Kirkbride Plan," a plan widely used for hospitals at that
time, and was done in what the architects called "Collegiate Gothic,"
a castled style complete with battlements and buttresses, popular in Victorian
times. The red bricks with which the first building was built were made from
the soil of the tract, and woodwork came from the trees of the surrounding
forest. Center Building housed the entire Hospital in 1855--wards, kitchen,
chapel and an apartment for the Superintendent. Transportation was such at that
time that guests who came to the Hospital often had to stay overnight, so seven
bedrooms were provided. One rom, known as Miss Dix's room, contained the
immense bed she used. The "Director's Room" which was a part of the
apartment, now called the Staff Lounge, contains the desk on which Miss Dix
penned the basic law adopted by the Congress for the organization of the
Hospital. Five Superintendents, beginning with Dr. Charles H. Nichols (1855)
and ending with Dr. Winfred Overholser (1962), all lived in this apartment.
Now, besides the Staff Lounge, several rooms of the apartment have been made
into offices. A new Chapel, built on the grounds, replaced the old 1855 Chapel,
and that space is now a gymnasium for the patients. Little scientific knowledge
was available regarding mental illness a century ago, but kindness and
compassion were present. The so-called "moral treatment," advocated
first by Pinel, the great French reformer, in the care of the mentally ill, was
being adopted in the United States , when the Hospital was founded. The essence
of "moral treatment" was to provide congenial surroundings in which
mentally ill patients might learn from the example of normal attendants. This
meant that special attention was given to a hornlike atmosphere in the Hospital
buildings, and that a real effort was made to have the grounds beautiful. One
thousand trees were planted at Saint Elizabeths during the early years. They
were brought from countries all over the world and also from many of our own
States. In the years that have followed, these trees have become giants, and
some of them are surrounded now by their offspring.
The Civil War Years. The changing of the Hospital's
name was actually begun during the Civil War. Every available hospital in this
vacinity vas pressed into service to receive soldiers wounded on the nearby
battlefields. The Minie' ball, used in the guns of that period, shattered the
bones so completely that they could not be set, so limbs were often amputated
on the battlefield. Many Of these patients who survived were sent to "The
Government Hospital for the Insane," so a small factory for making
artificial limbs was set up on the grounds, and when the amputees were ready
for them, the artificial limbs were fitted. These men, who were here for some
time, refused to write home saying they were in a hospital for the insane; they
simply wrote they were at "The Saint Elizabeths Hospital." The name
was used so frequently that in 1916 Congress officially changed it to Saint
Elizabeths Hospital, and for some unknown reason the apostrophe was left out.
Railroads, laundry, Bakery, etc. The Hospital,
until 1967, operated a small railroad that was probably the last steam,
coal-fed switch engine in the country in regular use. Every fall and winter it
ran along its mile of track to the main railroad, bringing the many tons of
coal necessary to heat the hundred and twenty-five buildings on the Hospital
grounds. A bakery that supplies bread and doughnuts, and the icehouse are still
in operation, as are the memmoth laundry, machine, electric, and other shops.
Patients who would benefit by working in these various installations are
assigned by their doctors to the different activities. Some patients thus learn
skills that can be helpful to them when they leave the Hospital.
Not Wedded to Any System Saint Elizabeths is known
throughout the world for its humane and expert services to more than 5,000
patients, and for its adoption of new methods of treatment as they become
known. When the Hospital opened under the leadership of Dr. Charles H. Nichols,
the first Superintendent, very little was understood of psychotherapy or
psychodynamics. Great emphasis was being placed on the earlier-mentioned
"moral treatment," and Saint Elizabeths was built with this idea in
mind. Dr. W. W. Godding, Superintendent (1877-1899), began to consider brain
surgery, and thought it possible that hypnotism would help the mentally ill. He
said, "We undertake to be old fashioned or any fashioned if by any
measures we can save some (patients). We are not wedded to any system . . . .
" In 1884, re-appointed a pathologist to the Hospital staff, Dr. I. W.
Blackburn, who was one of the pioneers in neuropathology in this country. This
was hailed as a new departure in this field. Another innovation at Saint
Elizabeths was hydrotherapy in 1897. But before that, in 1894, one of the early
schools of nursing was begun. Dr. Gadding was succeeded, on his death in 1899,
by Dr. A. B. Richardson, who died in 1903. Dr. Richardson's regime is best
remembered by the large number of buildings whose construction was begun at
that time, a practice he initiated of giving lectures to medical students, and
for establishing one of the early photographic departments and pathological
museums. When Dr. White succeeded Dr. Richardson in 1903, he established one of
the first psychology laboratories in the country. His interest in
psychotherapy, and the individual attention to the patient, is illustrated by
the fact that in 1917 he named one psychiatrist as clinical psychotherapist,
freeing him entirely from administrative duties. Another important innovation
made by Dr. White was the establishment in 1920 of the Department of Internal
Medicine, now known as the Medicine and Surgery Branch. He also developed the
School of Nursing, initiating the three year course, and set up occupational
therapy and social work. In 1909, he began publication of The Bulletin, a
Medical paper, which appeared at intervals until 1932. These are only a few of
the many advances made in treatment at Saint Elizabeths during Dr. White's
administration. Dr. White died in 1937, and Dr. Winfred Overholser was
appointed Superintendent. Having been Commissioner of Mental Diseases for the
Commonwealth of Massachusetts, supervising 16 State hospitals and numerous
private hospitals, Dr. Overholser was already widely experienced in the field
of mental health. According to Dr. Zigmond M. Lebensohn, the cause of forensic
psychiatry could not have been better served than by President Roosevelt's
appointment of Winfred Overholser, who became known as the "Dean" of
forensic psychiatry. To the present day, every type of psychotherapy, from the
original milieu therapy to psychoanalysis, has been used at Saint
Elizabeths--group therapy, occupational therapy, recreational therapy, dance
therapy, etc., as well as new medication as it became available. When Dr.
Overtholser retired in October 1962, Dr. Dale C. Cameron, who had been Director
of Medical Services for the State of Minnesota, was appointed Superintendent.
His tenure was notable for administrative progress including decentralization,
delegation of patient treatment, authority and outplacement. The patient
population began to decline despite increased rate of admissions. He also was
responsible for significant enlargement in the Hospital research and training
programs. In August 1967, Secretary John W. Gaxdner announced the transfer of
Saint Elizabeths Hospital to the National Institute of Mental Health (NINH),
effective August 13. In the following month, Dr. Cameron retired as
Superintendent to become Chief, Drug Abuse Unit, World Health Organization in
Switzerland, and Dr. David W. Harris was appointed Acting Superintendent. On
November 8, 1968, secretary Wilbur J. Cohen and Dr. Stanley F. Yolles, Director
of the National Institute of Mental Health, announced plans for the National
Center for Mental Health Services, Training, and Research, with three
divisions, one of which is the Saint Elizabeths Hospital - Division of Clinical
and Community Services, with Dr. Louis Jacobs as Superintendent of the Hospital
and Director of the Division of Clinical and Community Services. Dr. Harris was
at that same time appointed Assistant Superintendent. Dr. Harris, on January
31, 1969, resigned to become Chief of Staff at the Veterans Hospital in
Montrose, New York. During the period of the National Center for Mental Health
Services, Training, and Research, with Dr. Sherman N. Kieffer as its Director
and Dr. Jacobs as the Hospital Superintendent, a new era of community based
psychiatry began at Saint Elizabeths. The Hospital established its first
comprehensive Community Mental Health Center in April 1969. Between late 1969
and early 1970, all 19th Century patients' buildings were evacuated by
relocation-approximately 1,200 patients were moved to newer buildings or
outplacement in the community. Dr. Jacobs retired on November 3, 1969, to
become Chief, Division of Mental Health, Montgomery County Health Department,
Maryland, and Dr. Luther D. Robinson was designated Acting Superintendent. On
May 26, 1972, Elliot L. Richardson, Secretary of Health, Education, and
Welfare, approved an organizational change within the National Institute of
Mental Health, the effect of which was to deactivate the National Center for
Mental Health Services, Training, and Research, and to transfer to the Hospital
those training and research activities of the National Center which are
integrally related to its clinical operation. Emphasis on community service
continued. By the time of the close of the National Center, the Hospital's
inpatient population had decreased from 5,474 to 3,583, and the outpatient
rolls had expanded from 1,675 to 2,437. By 1978, the number of inpatients had
been reduced to approximately 2,200 and the number of outpatients expanded to
approximately 3,300. On June 29, 1972, Dr. Robinson, the Acting Superintendent,
was appointed Superintendent of Saint Elizabeths Hospital. Dr. Robinson had
been on the staff since 1955 and in 1963 had founded the Hospital's Mental
Health Program for the Deaf. During his superintendency, progress continued in
Saint Elizabeths' programs. Dr. Robinson was a frequent visitor in the wards
and earned the confidence of patients, many of whom he knew by name He
continued his research on mental health in deafness, and expanded the
Hospital's program for deaf people. When in July 1975 he moved to another
position in the Hospital after 5 years in the Superintendent's office, the
Director of NIMH, Dr. Bertram S. Brown, expressed thanks for the stability and
leadership Dr. Robinson had provided during very difficult years in the mental
health field. Dr. Roger Peele, Assistant Superintendent, served as Acting
Superintendent until October 1977, when Dr. Charles Meredith becomes the
Hospital's ninth Superintendent. He served from October 1977 to December 10,
1979 as Superintendent. William H. Dobbs, M.D., was appointed as Acting
Superintendent. He served as Acting Superintendent until he was appointed as
the Hospital's tenth Superintendent on January 14, 1981. Dr. William G.
Prescott was appointed as the Hospital's eleventh Superintendent on January 1,
1984, replacing Dr. Dobbs who asked to be relieved of the Superintendency. As a
result of changing Federal priorities and the increasing mental health
capabilities of other governmental agencies, some categories of Federal
beneficiaries eligible for admission to Saint Elizabeths, including: members of
the Army and Navy, beneficiaries of the Veterans Administration, Merchant
Seamen and Indians from the reservations, have been eliminated. As the
proportion of Federal beneficiaries at the Hospital has decreased over the
years, the proportion of D.C. residents has increased to approximately 90% of
admissions. The high proportion of D.C. residents, coupled with the stated
desire of the Federal government to get out of direct treatment services, and
most recently the advent of D.C. Home Rule, have been the catalysts for intense
negotiations by the Federal government to encourage the District of Columbia to
assume responsibility for the operation of a unified mental health system for
the city. The culmination of these negotiations is Public Law 98-621, which
mandates that the District assume full responsibility for providing mental
health services effective October I., 1987.
New Methods Adopted Saint Flizabeths was the
first public hospital to have psychodrama, and in 1944, what is now the largest
clinical pastoral training program in the Nation was begun. In 1957, the Saint
Elizabeths-National Institute of Mental Health Collaborative Program was
initiated--the Neuropharmacology Research Center in that year, followed by the
Behavioral and Clinical Studies Center in 1961. Many prominent professional
people have trained at Saint Elizabeths Hospital; and visitors from all over
the world come to the Hospital. Overlooking the Capital City of the Nation, the
Hospital is close to one of the great cultural centers in the world, as well as
one of the most beautiful cities
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