Madness in the City of Magnificent Intentions

This book is a history of the federal mental institution Saint Elizabeths Hospital and its relationship to Washington, DC’s African American community. Founded in 1855 to treat insane military personnel and the District’s civilian residents, the institution became one of the nation’s preeminent research and teaching psychiatric hospitals. From the beginning of its operation, Saint Elizabeths admitted black patients, making it one of the few American asylums to do so. The book charts the history of Saint Elizabeths from its founding to the late 1980s, when the hospital’s mission and capabilities changed as a result of deinstitutionalization and its transfer from the federal government to the District. The book makes two main arguments. First, ideas of racial difference figured prominently in how hospital officials understood the mission of the institution and subsequently designed and operated it, in how hospital officials understood mental disease and developed therapies to address it, and in how patients experienced their confinement. This history reveals the ways the American psychiatric profession engaged in an unarticulated project that conceptualized the white psyche as the norm. Second, this book argues that African Americans—both patients and nonpatients—were not powerless people acted on by large institutional forces. Black Washingtonians were active agents in their interactions with the hospital, from more overtly political and collective endeavors, such as calling for investigations of the mistreatment of black patients and advocating for the hospital’s integration, to the more individualized and quotidian attempts to manage their own or their loved one’s therapeutic experience.