Each weekday morning, John Hinckley, Jr. walks down the meandering road from the John Howard Pavilion to Building CT-6, where he works as librarian and archivist in the medical library. Here he sits among the stacks of psychiatric journals and medical textbooks, doused in florescent lighting, archiving documents and reading at his leisure. With his light blond hair and boyish pudge, Hinckley retains a certain youthfulness at 48. For nearly half his life, he has been the most famous patient at St. Elizabeths Hospital in Southeast D.C. It is Hinckley’s recent hearings requesting unsupervised visits off-campus that have again garnered the hospital national media attention.
St. Elizabeths remains an intriguing outpost of American history nestled on high bluffs overlooking the Anacostia River. Straddling both sides of Martin Luther King Boulevard in Southeast Washington, this complex of almost 150 buildings has been the site of considerable psychiatric research and has housed many notorious characters in its 149-year history. Most of the tragedies of the patients who have passed through the gates of St. Elizabeths remain untold, personal. Their stories will forever be relegated to obscurity. Hinckley’s tragedy is only remarkable in the way it unfolded on the national level. “In the tragic cases of our century there are times when mental illness intrudes onto the life of the nation very catastrophically,” said Rev. Clark S. Aist, head chaplain of St. Elizabeths.
In his attempted assassination of Ronald Reagan, Hinckley emulated the plot of “Taxi Driver,” hoping to impress Jodie Foster, who grew to be his real-life obsession. He had stalked Foster at Yale University earlier that year, sending her numerous cards and letters and even speaking with her on the phone. He carried through with his deluded attempt to impress the young Foster on March 30, 1981, firing six shots at Ronald Reagan as he exited the Washington Hilton on Connecticut Avenue. The President survived, a bullet missing his heart by inches. James Brady, White House Press Secretary, received a bullet to the brain, leaving him partially paralyzed.
In a note found in his Park Central Hotel room after the shooting, Hinckley wrote, “Jodie, I would abandon this idea of getting Reagan in a second if I could only win your heart and live out the rest of my life with you.” Five pictures of Foster were found on his person that day.
Hinckley has lived as a patient in the maximum security John Howard Pavilion at St. Elizabeths since he was found not guilty for reasons of insanity 22 years ago. After leaving his work in the library, he has free, unaccompanied run of the grounds in the afternoons, time he often spends tending to stray tabbies he has befriended.
During the ‘80s, Hinckley was caught corresponding with serial killer Ted Bundy, and a cache of 57 hidden pictures of Foster were discovered in his 10-by-15-foot room. However, since these initial missteps, he has undergone extensive therapy, and his psychiatrists consider him to no longer be a threat.
Martin Luther King Boulevard bisects the 336-acre hospital grounds, dividing St. Elizabeths’ grounds into the East and West campuses, containing 144 buildings between them. In 1987, an act of Congress turned the East campus over to the D.C. government. Until a few years ago, some buildings on the West campus still were used to house patients, but in January 2003, hospital operations were consolidated into 15 buildings on the East campus. Only two of the nine gates on the hospital grounds are now used, policed by Allied Security, the same company that provides guards for Georgetown dormitories at night.
The now abandoned West Campus is completely closed off to visitors while the fate of the property is decided. Weeds fill the cracks in the pavement, and the antebellum structures beckon from behind the high brick walls. Both Hinckley and the hospital are about to go through some major changes.
St. Elizabeths, declared a National Historic Landmark in 1990, differs from other still abandoned public property in D.C., such as the former D.C. Convention Center. A development plan for St. Elizabeths’ West Campus must incorporate the existing historical structures. RTKL Associates, a planning and design firm, will be the coordinating architect for the redevelopment of the D.C. Convention Center, as well as the director of development for the West campus.
“There are over four dozen historic buildings which have to be restored and adaptively reused. That becomes a challenge because many of these are smaller buildings which would suit individual small business uses, and some would lend themselves to becoming apartments,” said Greg Powe. Powe, an architect at Powe Jones Architect PC, worked as a consultant to the D.C. Office of Planning from 2002 to 2003, and helped to select the RTKL Associates as the firm to lead the development process.
In 2002, the Urban Land Institute, a non-profit development think tank, gave Powe and the D.C. government their assessment of the development options for the West Campus. The Urban Land Institute concluded that the land naturally broke up into four to five different sub-neighborhoods, which would lend themselves to a mixed-use development for business, community residences, higher education, cultural and recreational sites.
To engage the local community in the planning process, D.C. Mayor Anthony Williams held a community workshop to discuss redevelopment of the West Campus on April 5. The proposal drafted at the meeting stated, “the plan should include a mix of uses such as residential, commercial and institutional. Educational and recreational opportunities should also be incorporated in the framework plan for children, adults, families, the mentally ill and seniors.” Reconciling the goals of the community with the costs associated with renovating the buildings is plausible with thoughtful planning on the part of the development team.
The delay in the campus’ development is partially due to the interest the Department of Homeland Security voiced in using the property as its headquarters. The view of the capital and its proximity to downtown were attractive options, but ultimately the idea was dropped because the historical buildings could not be accomdated in the design for the headquarters.
In the past, St. Elizabeths was completely self-sufficient, supplied by an on-campus working farm and dairy. Since 1998, after the closure of the last grocery store in Ward Eight, Urban Oasis Community Farm, a one-acre organic farm on the St. Elizabeths campus has provided the local community with a source of fresh fruits and vegetables. With redevelopment of the grounds in the works, the future of this project is uncertain.
As understandings in psychiatry shifted in the 20th century, sprawling insane asylums around the country were abandoned in favor of smaller, more efficient localized treatment centers and modern medicines. “We had to completely rethink understandings of psychiatry, so the psychoanalytic foundations, which catapulted St. Elizabeths into a world-class institution, were eclipsed by the later developments of our understanding of the brain,” Aist said. The population at St. Elizabeths has steadily declined from 7,000 to around 500 today.
The smell of hospital, antiseptic and sickly sweet, lurks even in the chapel where Aist’s office is located, filled with manila folders and psychiatric books. An eloquent and pensive man, Aist wears his D.C. Mental Health I.D. card around his neck over his vaguely floral tie. Growing up in Southern Maryland the son of a dairy farmer, Aist remembers visiting St. Elizabeths in 1940 as a four-year old boy. Labor shortages had caused his father to inquire at the hospital about hiring patients as herdsman for his cattle. In 1968, after attending Methodist seminary, Aist returned to St. Elizabeths as a chaplain. Holding a doctorate in counseling and psychology from American University, Aist also serves as Chief of Clinical Rehabilitation at the hospital. Aside from providing pastoral care and clinical support to patients, he is also a scholar of the hospital’s history.
In 1852, an act of Congress provided funding to build the first federal mental institution. Guided by the principles of hospital reformer Dorothea Dix, the hospital would provide enlightened and humane care to the mentally ill of the Army, Navy and District of Columbia.
St. Elizabeths would pioneer “moral treatment,” in the spirit of hospital reformer Dorothea Dix. “It was not the Renaissance, nor the Reformation that brought help to the mentally ill, it was the Enlightenment. The recognition that these people are not possessed by demons, that they are truly human beings and we need to treat them in hospitals, because they have an illness,” Aist said.
Congress appointed Dr. Charles Nichols as the first superintendent, who would oversee the construction and administration of the hospital. Nichols surveyed the surrounding countryside, finally deciding on the “St. Elizabeth’s tract” across the Anacostia River in what was then rural Maryland.
“The zeitgeist of the time was that people with a disordered mind need to have the virtues of a rural environment. This is a time when cities were bad: they caused disease, they were crowded and they made you crazy, or at least a lot of crazy people seemed to live there,” said Aist. “Well into the 20th century, urban congestion was seen to be a cause of mental illness.”
With the site chosen, Nichols commissioned Thomas Ustick Walter, Architect of the Capitol, to design the Center Building and the adjoining East and West Buildings. As funding was low, bricks were crafted from the local soil and a perimeter wall was fashioned, at first from the local craggy red rock and later, from red brick.
During the Civil War, both Union and Confederate soldiers were treated at the hospital, which gained renown for the expertise at amputations. Ashamed to be convalescing at the “Government Hospital for the Insane,” soldiers began referring to the hospital as “St. Elizabeths” in their letters. The name stuck, and was officially adopted in 1916. Somewhere along the way the apostrophe was lost.
Before MRI and CT scans, the only way to study the brain was to slice it up. On the walls of the main hallway in the Blackburn Laboratory of Pathology hang a series of bulky wooden frames containing cross-sections of brains. The brain slices in this 1931 exhibit, suspended in a formaline preservative and encased in clear plastic plates, come from autopsies performed on patients who died at the hospital. It was just coming into consciousness that the conditions lurking in the brains of the institutionalized-cerebellar atrophy, cerebral abscesses, hemorrhages, and encephalitis-could affect behavior and cause mental illness. Some of slices of gray matter, yellowed with age, are more reminiscent of discolored and unappetizing Swiss cheese than anything else. Yellowing handwritten information cards accompany the specimens, painstakingly detailing the behavior and medical history of the patients and the findings of the autopsy.
Mussolini’s brain enjoyed a brief interlude at St. Elizabeths, analyzed there by U.S. Army pathologists after the war. In 1966, the brain matter was returned to his birthplace in Predappio, Italy, where it rests on his tomb in a box, beside a marble bust of his head.
The hospital donated the bulk of its “brain trust,” the 15,000 specimen Blackburn-Neumann Collection, to the National Museum of Health and Medicine in 1993. Hospital research from 1884 to 1982 cultivated this expansive collection of brain tissue, autopsy files and microscope slides. Included in the collection are the brains of lobotomized patients and of those shocked with electricity and metrazol, a chemical used to induce convulsions and coma.
The development of thorazine and other anti-psychotic drugs, psychoanalysis lost some of the prominence it had previously enjoyed. “When I came to St. Elizabeths in 1965, the view was that these medicines would make patients more amenable to psychoanalytic treatment. But in all truth, psychoanalysis really wasn’t as helpful as we had hoped, and more and more we began studying these new drugs,” said Aist.
The population at St. Elizabeths today, though vastly decreased from its historical highs, is harder to treat. “However, this population contains category of patients whose recovery is very complicated because of a variety of co-occurring disorders, because of cognitive deficits, substance abuse in particular,” Aist cautioned. “This means that they don’t respond as well to our treatment, medication and they don’t maintain recovery very well, they don’t maintain compliance with their regimens, therapy and medications. So our challenge today is to provide active treatment, genuinely active treatment.” St. Elizabeths, under the guidance of Chief Executive Officer Joy Holland, is working today to provide this kind of active care. Since coming to the hospital two years ago, Holland has opened a “treatment mall,” a place where in-patients go during the day to participate in regimented treatment activities involving group therapy and creative expression.
St. Elizabeths prepares to enter the next phase of its history with the construction of a new hospital. Designed by D.C.-based architecture firm Einhorn, Yaffe & Prescott, the 292-bed hospital will lie partially in the existing footprint of the John Howard Pavilion, which will be demolished. This modern hospital will be one of only four remaining buildings used by the hospital. The fate of the rest of the land remains uncertain.
As the seat of the federal government, D.C. has a marked propensity for attracting the mentally ill. Over the years, St. Elizabeths has housed delusional people who have caused a disturbance at the White House or other federal facilities and been taken into Secret Service custody. According to Secret Service Special Agent Frank Benedetto, St. Elizabeths, as a federal facility, is “logistically and operationally where we would bring someone if the judge says they need psychiatric care.”
Though unable to release any specific statistics, Benedetto stated the courts “frequently” deem that someone in Secret Service custody requires psychiatric evaluation. “People who might run into us out there in an unfortunate way would be taken there because it is the primary mental health facility for the area.” With the new hospital building in the works, the Secret Service doesn’t anticipate any changes in the way they do business with St. Elizabeths.
One of the hospital’s first patients, admitted in January 1855, was Robert Lawrence, who had attempted to assassinate Andrew Jackson 20 years earlier. On Jan. 30, 1835, in the first ever attempted presidential assassination, Lawrence fired two pistols at Jackson, which both misfired. During his trial, the attorney for the District of Columbia at the time, Francis Scott Key, persuaded the court that Lawrence was not guilty for reason of insanity.
Almost 100 years before Hinckley’s attempted assassination of Reagan, another presidential assassin came to reside at St. Elizabeths. Charles Guiteau, a failing lawyer and disgruntled former supporter of President James Garfield, shot the President on July 2, 1881. Garfield, en-route to vacation at the Baltimore and Potomac Railroad Station in D.C., was hit in the arm and back. Garfield lingered on for more than two months, and an epic seven-month trial ensued for Guiteau, during which time he stayed at St. Elizabeths. Supported by a team of psychiatrists headed by Dr. Nichols, Guiteau pled insanity. He was ultimately found guilty, and was executed on June 30, 1882.
Pathologists at St. Elizabeths performed Guiteau’s autopsy, discovering his brain was ravaged by neurosyphillis. “We really have to be very careful in our assessments of the possible complications of mental illness, when you have such cases as that, when you have someone shooting somebody and they don’t know what they’re doing. That’s very different from, I think, John Wilkes Booth, who committed a political, deliberate, and very well planned act, probably not complicated by mental illness, like Guiteau,” Aist said.
Since a court victory in 1999, Hinckley has enjoyed more than 200 visits off the grounds of St. Elizabeth, accompanied by hospital personnel and other inmates. He is trailed by the Secret Service at these times, and has visited D.C. area bookstores, bowling alleys and restaurants. Thus far, these visits have been uneventful, despite his being recognized on several occasions.
On Dec. 17, U.S. District Judge Paul L. Freeman granted Hinckley a series of six unsupervised day visits in the D.C. metro area with his parents, on a trial basis. If these day trips go smoothly, the hospital review board will allow Hinckley to take two overnight stays in the area with his parents.
Though the details have yet to be finalized on how closely the Secret Service will monitor Hinckley on these “unsupervised” visits, past examples can serve as a reference. “What I can say is that when he’s left the grounds we have been aware of his movements,” Benedetto said.
Though the Reagan and Brady families are opposed to Hinckley receiving more freedom, his psychiatrists at the hospital believe he has been rehabilitated from the psychosis he suffered from in the ‘80s. “He’s been institutionalized there because he was found not guilty by reason of insanity. If he had been found guilty he’d probably be out [of prison] already, according to 1981 laws,” Benedetto said. Hinckley takes his antipsychotic medication now only as a precaution. Though Aist personally has had minimal interaction with Hinckley, he maintains that “a body of opinion exists at St. Elizabeths that suggests Hinckley has been rehabilitated.”
As Hinckley embarks on the first of his unsupervised visits this month, he grows closer to his release. Hinckley has to become an ordinary man if he wants to live in society. Aist said, “I think one of the things that has been part of his recovery is to become not an extraordinary person, but an ordinary one.”
