Western State was the second public mental hospital in Virginia and one of the early American institutions designed under the moral treatment model. The site at Staunton was chosen partly for convenience - the Valley Turnpike improvements of the late 1820s made transporting patients from across western Virginia easier - and partly for a sense that Staunton would become a city of educational institutions. The Virginia School for the Deaf and the Blind would open here in 1839. The early architecture of the asylum reflected genuine optimism: the Main Building, completed in 1828; the North Building, finished around 1840; a chapel from 1843. Patients were assigned chores in the gardens or kitchens, walked the grounds, and received what 19th-century medicine could offer. For a while, the model seemed to work.

By the mid-19th century, the resort-style asylum had vanished. Demand outstripped capacity. Funding lagged. The wards filled and overfilled. Restraints became routine - ankle and wrist cuffs, straitjackets, locked rooms. The institution was renamed Western State Hospital in 1894. After the 1920s, the hospital became one of the principal Virginia institutions implementing the Virginia Sterilization Act of 1924 - the same law upheld by the Supreme Court in Buck v. Bell. Patients judged unfit to reproduce were sterilized without meaningful consent. The practice continued until the law was finally repealed in the 1970s. Electroshock therapy and lobotomies were performed at the hospital during the mid-twentieth century. The numbers of patients who passed through these wards run into the tens of thousands; the Library of Virginia maintains their records and has made some accessible, allowing families to trace ancestors who disappeared into the system.

In the 1970s, the hospital moved its operations to a new site near Interstate 81. The Commonwealth converted the original campus into the Staunton Correctional Center, a medium-security men's prison. For more than two decades, walls that had held patients now held inmates. The prison closed in 2003. The buildings stood vacant for years. In 2005, Virginia gave the property to the Staunton Industrial Authority. Developers proposed a residential and mixed-use campus called The Villages at Staunton; the first condominiums went on sale in early 2008. In 2018, a renovated portion of the complex opened as the Blackburn Inn and Conference Center, which was inducted that same year into Historic Hotels of America. Guests now stay in rooms that were once wards. The chapel hosts weddings.

The Western State Hospital Complex includes 22 contributing buildings and four contributing structures, all on the National Register of Historic Places since 1969. Among them are the original Main Building, the North Building, the chapel, Ward 3, the Dairy Barn, the Boiler Plant, and a series of doctors' residences. The architecture survives. The buildings have been restored carefully enough that visitors notice the craftsmanship: brick patterns, window proportions, the long porches that once let patients sit in the open air. What is harder to preserve, and harder still to interpret, is the long middle chapter when these buildings were instruments of harm. Some of the families whose ancestors were sterilized here can now stay in the building next door. That is not a tidy resolution. It is, perhaps, the most honest one a site like this can offer.