Madness: Race and Insanity in a Jim Crow Asylum

by Antonia Hylton

was desperate for my loved one to get better, and I was tired of standing in the park shivering. I was starting to despise this place, as it transformed from the soothing foundation of my childhood into a reminder that I had been told I shouldn’t go inside my loved one’s home any longer. I was also shaking from immense shame. Shame, because days earlier, I had begged a police officer who had entered my loved one’s home to tell his fellow officers to never shoot. I had spoken to the officer at a mile a minute, listing every single one of my loved one’s credentials. A pitiful feeling had come over me, making me convinced I should try to prove to this officer that my loved one was a good and worthy person.

treatment. My loved one says they’ve experienced the same patterns of condescension and disrespect from emergency rooms to state-of-the-art facilities. All they wanted was for someone to listen to them tell their story and to show them empathy. “Toward the Black patients especially there’s an attitude of ‘Don’t even talk to me,’” they explained. “It’s a form of remote incarceration. You’re really not trying to deal with the person in a human way.” Doctors gave my loved one a diagnosis that was so ambiguous and confusing, it seemed, to them, like “it would have covered about half the population.”

Throughout the nineteenth century, one doctor by the name of Dr. Francis Stribling created a set of criteria for the care of Negroes in asylums. Primary to his criteria was that Black and white people were different and must, therefore, be treated separately. He also believed a patient’s cure should involve work that was similar to what that person did prior to hospitalization. For Black people, that meant more unpaid physical labor.

Throughout the 1800s, a growing fear of slave rebellion inspired owners to become increasingly vicious. By 1860, an estimated eight hundred slaves had escaped bondage in the state. Uprisings and rebellions by enslaved Black people led to backlash, and slavers murdered, shot, whipped, and tortured African Americans. Free Black people were a direct threat and contradiction to white Marylanders’ way of life, and some groups began to advocate for the exile or re-enslavement of free Black people. To be Black in America then was to live in a daily state of degradation, violence, and trauma. For most, treatment and support were nonexistent.

be more likely to die there than find their way home. The laborers who had toiled over the grounds were marched inside the buildings, into rooms they had hammered into place, and admitted as the very first patients. But that would not mark the end of their days of work. In addition to planting and harvesting crops on the Crownsville campus, the patients “were taken in motor trucks to adjoining farms within a radius of ten miles,” where they “gathered the crops for the farmers who were without help.” The twenty-eighth Lunacy Commission report boasted about how useful it was to have a captive work force that they could send about town. “This is only a demonstration of how practical it is to have a group of patients under the supervision of a careful attendant.”

By 1920, the Crownsville Hospital property was worth almost half a million dollars. There to serve the more than five hundred patients at the time were two physicians and seventeen nurses. That year, twenty-eight patients were discharged as improved, eleven more were sent home despite a lack of improvement, and a shocking ninety-seven people died.

spoke with three former employees who grew up in Annapolis and Baltimore and recalled that well into the 1960s, it was common knowledge that Crownsville patients were rented out to local companies looking for cheap labor. Two of the employees were told that the patients were paid about fifty cents per day. While they might receive a part of their wages,

Historians of slavery and prisons have long argued that the commercial value of enslaved Black people in the American South was inextricably bound to their health status and their capacity to labor in the agricultural or domestic settings that had defined the Southern economy. Crownsville’s founding took vestiges of chattel slavery—from the style of the rolls to the financial recordkeeping format used on plantations—and translated them to a clinical setting.

The function of lynching was so much more than a bypassing of the justice system. It was a form of psychological terrorism. And it sent several messages. One basic message was that they had killed people like Williams and Armwood before and, if necessary, would do it again.

But the more subtle and crucial message was that they still owned Black people. That they could sever their body parts, and continue to have complete and utter dominion. They controlled their livelihoods and their prospects. They could take ownership of people seen as destitute, different, and strange. They also owned the narrative. Each lynching stole the life of its victim, but it also wrought immeasurable trauma on every Black person who witnessed or heard the story. Between 1889 and 1930, 3,724 people were lynched in the South; over four-fifths were Black. In almost every case, no serious effort was made to identify and punish lynchers. How could you not go mad?

The core issue behind Crownsville’s dysfunction, and what truly set it up for violence and struggle, was the persistent funding and reputational disparity. Uria was a victim of physical violence, but he was also a victim of the bizarre and negative cultural capital associated with the state’s only Black asylum. The biases that kept officials from properly funding the hospital did not just hurt the patients—they also imperiled employees.

By the late 1940s, stories about violent escapes, aggressive Black men, and the anxieties of white residents were becoming routine. The press started advancing a narrative: Black patients at Crownsville, often painted as uniquely violent and disgusting, were to remain under increased supervision. Even as white patients deserved sympathy and the benefits of rehabilitation.

Over the years, Crownsville had developed into a dumping ground—a place that seemed to swallow the undesired, poor, and nonconforming Black residents of Maryland and, at times, deny them fundamental human rights. Black employees, many of whom came from the same neighborhoods and conditions as their patients, found themselves working under impossible and ethically compromising conditions. They were not always confident that their work was enough to outweigh the harm, but the alternative—a return to the days of a white-only professional staff—seemed far worse.

Black Americans refused to quiet their pain or to live as second-class citizens any longer. The backlash was swift, and American urban spaces became criminalized to a sweeping extent. Behaviors that had once been associated with poverty and illness became part of a growing list of crimes that could land you in jail.

cause.” As many historians have previously argued, rising hostility toward Black protest and criminality fostered much of this new enthusiasm for expansive policing initiatives—and those initiatives were often narrowly aimed at America’s Black citizens.

But the study and treatment of mental illness became especially vulnerable at that time. The field was essentially still in the Dark Ages—doctors were only just discovering medications and testing them out on patient populations that were warehoused, disorganized, long mistreated, and frequently misdiagnosed. Anxieties about race, resistance, and societal change crept into psychiatry and reshaped everything about the clinical context for all patients, not just African Americans. The Elkton Three were an example of this kind of infiltration, an early sign that some white leaders and doctors would, wittingly or unwittingly, misread Black anger as mental illness and use tools of psychiatry to punish, not to heal, the communities they were meant to serve.

Research continues to find that psychiatrists are more likely to diagnose Black men with schizophrenia and that Black people are more likely to be prescribed antipsychotic medications—and at higher doses. In a 2018 meta-analysis of fifty-two different studies, researchers Charles Olbert, Arundati Nagendra, and Benjamin Buck found that Black Americans are 2.4 times more likely to be diagnosed with schizophrenia than white Americans. Back in 2014, a separate study found clear patterns in which Black Americans were diagnosed at a rate three to four times as high as white people, and Latino Americans were diagnosed at a rate more than three times higher than white Americans.

Paul Lurz and about a dozen other employees told me this was an open secret. Paul explained to me that not only was it common for judges and hospital psychiatrists to “never [seem] to be in a rush” to evaluate those committed but that it was also common for the Baltimore police to pick up the mentally ill and homeless and leave them in the city jail. Then, Paul explained, they would be transferred to Crownsville, and his team would receive medical certificates for the transfer that were always signed by the same two physicians using the identical wording. “The rumor was that they simply walked past the jail cells, looked in, then filled out the committing certificates” that immediately transferred people from the jail to the hospital.

In 1952, less than 150 per 100,000 people were incarcerated in state and federal prisons, while over 600 per 100,000 were living in some form of asylum. And at the close of World War II, the ethnoracial makeup of American convicts was proportional to our national demographics: approximately 70 percent of the prison population identified as white and 30 percent as “other.” By the end of the twentieth century it had completely overturned to 70 percent African American and Latino and 30 percent white. Crownsville’s records suggest that, while the story is nowhere near as simple as one institution morphing into the other, it is no coincidence that the end of the twentieth century marks both the decline of the mental hospital and the expansion of the prison system. And so in trying to better understand what happened to America in this period, Crownsville urges us to start the story of mass incarceration a little earlier—at a time when the prison and the asylum coexisted.

For most of the twentieth century, state mental hospital patients were majority middle-aged and white, and our modern incarcerated populations are now predominantly young and nonwhite. It is precisely the fact that our incarcerated populations look closer to Crownsville’s demographics that led me and other journalists and historians to raise questions about who benefited from deinstitutionalization and who did not. Is it a coincidence that at the very historical moment when the asylum was being dismantled, the prison, which had collaborated and exchanged extensively with hospitals like Crownsville, rose to prominence? And how might the prison have relied materially and operationally on the asylum’s legacy?

In the years after the hospital’s closure, Crownsville employees found it deeply painful to travel into Baltimore or drive along Route 450 in Annapolis, where their former patients would be sleeping under bridges. Even from a distance, nurses and doctors could tell their patients had long been disconnected from their medication regimens. “Seeing so many of the patients then, you would know their faces from Crownsville. They would know you,” Joyce Phillip told me, describing her daily rides along Route 450. She had worked with patients who had been at Crownsville since they were teenagers, and the hospital was all they had known in adulthood. She started to question whether deinstitutionalization had been a noble project or an abject failure and a violation of human rights. “It’s hard to trust the current system that the right funding would ever be there.” She believed no patient should ever be brought back into the massive, abusive warehouses she saw at the start of her career in the 1960s. But some of Crownsville’s physicians told me they estimated that up to 90 percent of the homeless people they saw in the area in the early 2000s were former Crownsville patients. There had to be a better way forward.

We are confronted with a choice—when what we really want to do is to shirk responsibility. We are reminded that we are not so healthy and virtuous after all. We’re forced to consider the role we might have played in isolating our neighbors, and how crazy it was that we ever thought we could alienate them, cut funding for the programs that helped them, dispose of the park benches where they might have found rest, and then somehow avoid a public confrontation. It’s cruel. It’s madness.