Treating Race at St. Elizabeths Hospital

Today’s post comes from Ben Miller, an intern with the Exhibits team at the National Archives Museum.

On August 31, 1852, Congress appropriated $100,000 to create the government hospital for the insane in Washington, DC. Soon known as St. Elizabeths, the hospital was meant to be a “model institution,” providing the highest quality mental health treatment available and showing off American medical knowledge to the world. 

Remarkably, this vision always included African Americans. Even years before the end of slavery, St. Elizabeths accepted and treated a significant number of Black patients. But inclusion did not mean equality. St. Elizabeths aspired to model the best of American medicine, but it also modeled something else—the racist prejudices of American society.

Though St. Elizabeths always accepted African American patients, it segregated them within the hospital. Black men and women were initially housed in small, outlying buildings that did not have ventilation systems. As the hospital’s population grew after the Civil War, these “colored wards” quickly exceeded capacity. Even as new spaces for Black patients were constructed, they remained the most overcrowded parts of St. Elizabeths.

Racial separation at St. Elizabeths was shaped by more than just the everyday prejudices of segregated America. It reflected a common belief among psychiatrists that the minds of white and Black patients were fundamentally different. 

In his book Madness in the City of Magnificent Intentions, Martin Summers describes how “ideas of racial difference were foundational to the production and deployment of psychiatric knowledge” in the 19th and 20th centuries. In developing notions of the normal white psyche, medical professionals treated Black minds as inherently abnormal, unknowable, and typically incurable.

When diagnosing African Americans, doctors often filtered their observations through this racial lens. Symptoms like delusions, aggression, and paranoia that were concerning in white patients were often dismissed as built-in traits of the Black mind. Doctors at St. Elizabeths played a key role in advancing these ideas, publishing 10 studies between 1914 and 1933 that claimed to show fundamental differences between the hospital’s white and Black patients.

These racist notions shaped the care that Black patients received at St. Elizabeths. In the 1890s, the overcrowded hospital began to house Black men with criminally insane white convicts sent to St. Elizabeths. This choice leveraged common stereotypes about African Americans’ criminality to justify breaking the color line and grouping them with a much more dangerous class of patient. 

When the hospital began to adopt new treatment methods like psychotherapy in the early 1900s, these techniques were used almost exclusively with white patients. Black patients were instead channeled into what Summers calls “a labor regime that itself masqueraded as therapy.” In lieu of modern treatments, many African Americans were put to work around the hospital, with the goal of making them into “tractable laborers” upon their release.

Despite this discrimination, African American patients, families, and communities made St. Elizabeths work for them. In entrusting themselves and their loved ones to St. Elizabeths’ care, Black Washingtonians laid claim to government services that were typically denied to African Americans in the Jim Crow era.

Through letters, patients’ families advocated for their treatment and pushed the hospital to see and treat Black patients as individuals. Organizations like Howard University and the NAACP also challenged segregation at St. Elizabeths. Their efforts led the hospital to gradually integrate its wards in the 1950s and to hire Black nurses, doctors, and eventually an African American superintendent. These portions of St. Elizabeths’ story make it not only a model of America’s racist past but of the struggle to overcome it as well.

For more information on records at the National Archives relating to St. Elizabeths read the 2010 Prologue article, The Records of St. Elizabeths Hospital at the National Archives.