Madness: Race and Insanity in a Jim Crow Asylum

by Antonia Hylton

“There’s an assumption,” she told me, “that when a Black kid comes to the emergency department, the problem is behavioral. It’s not depression.”

We have fought hard and long for integration, as I believe we should have, and I know we will win, but I have come to believe that we are integrating into a burning house. —Dr. Martin Luther King Jr., as told to Harry Belafonte

Black nurses and aides weren’t entirely alone in the painstaking work of reform. Crownsville was a place of stability and community for another group of outsiders. When Dr. Jacob Morgenstern took the reins as Crownsville’s superintendent in 1947, the hospital was a relic of a fading but stubborn era.

In 1949, there were 1,800 patients and 392 staff members. Just five of those employees were Black. By 1956, there were 2,300 patients and 745 staff members, 326 of them Black.

In memory of and in gratitude to the Holocaust survivors who worked in ways big and small to make Crownsville better: Ludwig Benedict Stephen Klinger Gustav Meinhardt Hans Meyer Gisela Morgenstern Jacob Morgenstern Hildegard Reissman Joseph Rosenblatt Earnestine Sokal

One patient, a man named Mr. Bell, walked through the doorway and into the open space. Mr. Bell stood still. With Marie at his side, he tilted his head all the way back and looked up in awe. “I’ll be goddamned,” he whispered, “there’s the sky.”

Former Crownsville employees and even relatives of local law enforcement officers have repeatedly described how they received money in exchange for bringing people to the hospital. It’s part of what fueled the nightmares of Black Annapolitans, who used to worry about “night doctors” roaming the streets to bring someone to Crownsville under the cover of darkness. I have not been able to find any evidence of these transactions. There exist no receipts for payment or records describing a program of cash in exchange for patients. But several generations of employees and families shared these stories with me.

Before Crownsville, this patient had been living on the Eastern Shore. One afternoon, the woman stepped onto a busy road and startled a horse. The horse reared back and frightened its rider, a local white woman. For the “crime” of frightening a white woman on a road, this woman spent years at Crownsville. That was all Joyce could see in documents about her psychiatric history.

“You’d read stories like that, that had no reason why they should be in Crownsville,” Joyce said to me incredulously. “They came to Crownsville and never got out.”

Former patients have spoken and written about Crownsville the way formerly incarcerated people do of their time in prison. Their instincts, their ways of thinking, their movements are broken down and readjusted to fit this world with its own rules. As time goes on, it becomes harder and harder to feel like part of the outside world, to know they have a place in it if they ever find their way back.

I wanted to know more about the moral gray areas, the painful decisions, the bizarre balance of power between white employee, Black employee, and Black patient.

Clinical notes often privilege the provider’s point of view and enforce hierarchies and power. Doctors and nurses were the ones who decided what was valuable information and what would constitute the story of patients’ lives behind Crownsville’s walls. And of course, to make matters more fraught, most of the clinical-level staff were white people writing about Black patients in this period.

Then, Donald realized that a lot of the patients he met were admitted only because county jails were too full.

The student went to Betty Hawkins. “Let’s call him right now,” Betty said. Everything the patient said was true. His brother had been looking for him for years and had no idea where he was. He thought his brother had been kidnapped or killed, but he was just waiting around at Crownsville the entire time.

Another patient Betty worked with had been at the hospital for twenty-seven years. Betty, worried about how isolated this patient had become, contacted their relatives in Baltimore. The family was in shock. They, too, had no idea their loved one was there. They immediately drove over to the hospital to bring him home. For twenty-seven years, a Baltimore family had assumed the worst.

“Segregation was expensive,” the article read, “and the people who suffer most when budgets are cut are the patients in the Jim Crow institution.”

But a lot of kids on the adolescent ward simply wanted to be adopted. In Paul’s view, an asylum overflowing with adults—some mentally ill, some accused of crimes, many discarded—was no place for a child who was searching for a guardian.

But this hospital was not a sensational snake pit, full of caricatures instead of people. In my research, I’ve found that most of the employees—especially the longtime ones—entered Crownsville desperately trying to make it better.

Is it worth it, doing incremental good in an imperfect system? Can you be a good person and work somewhere where something like this happens?

that doctors at Johns Hopkins extracted from Elsie’s mother and used without her consent to develop an immortal, and seemingly invaluable, human cell line, known as HeLa. But as her mother’s cells were transformed into billion-dollar drugs and vaccines, Elsie was at Crownsville. The evidence suggests she was used by science, too.

Elsie was ten years old when she arrived at Crownsville. She was only fifteen when she died there alone.

What they likely didn’t know at the time was that the field they were entering was trying to rapidly professionalize, even as its leaders and practitioners were scrambling in the dark. Every early development and disease categorization, and every plan for how to treat a child like Elsie, was being touted as a great advancement. In truth, they were treating symptoms, and they knew next to nothing about the origins of mental illness and distress.

In the midst of this push, in the fall of 1954, the APA notified Superintendent Arnold Eichert that Crownsville failed to meet basic standards and would not be approved for accreditation. The APA echoed what patients and their families had been saying for years: Crownsville was severely overcrowded and understaffed.

The APA recommended that Crownsville establish specialized departments, create formal residency and training programs, and perform medical research through ties to nearby universities.

Between 1952 and 1960, a flurry of studies involving Crownsville patients are mentioned in the records, although I was never able to find any summaries or conclusions of their findings.

This research ranged from studies on the intelligence of children and people with personality disorders to patients with syphilis, sickle cell, or lung cancer, and experimental procedures on people living with epilepsy, like Elsie.

In the years before anti-psychotic medication, the primary treatment available to patients at Crownsville was hydrotherapy. In bathrooms and communal showers, aides would set up deep soaking tubs. They’d take the most troublesome patients and submerge them into extreme temperatures. A large white sheet would wrap around the tub, leaving only a small space for the patient’s head to poke through. Patients would sit there, unable to move or lift their limbs, for hours or even days in icy or burning-hot water.

Often, they said, nurses would place patients in the tubs not because they believed water would cure much, but simply with the hope that it might keep a patient quiet for a while.

When Jacob Morgenstern took over as superintendent in 1947, he expressed his extreme discomfort with the practice, and the number of lobotomies quickly plummeted. They weren’t nonexistent, though. A report I obtained from April 1950 noted that a Crownsville patient named William traveled to nearby Baltimore City Hospital for a lobotomy. There was no information about the procedure or his symptoms. All I could find, among other routine administrative announcements, was the news that William had died following the lobotomy. He was only thirty-three years old.

One day, in the 1960s, George was on Crownsville’s campus, walking through a parking lot that sits between the Winterode Building and the one-floor medical-surgical center. He started snooping, descending an outdoor cement staircase that led to the hospital’s lab and morgue. He walked into the laboratory, where the lights were down and no one else was around. In the center was a large chemist’s table with clear jars scattered about. It looked to George like each jar held a different human body part suspended in a putrid yellow-green fluid. He looked closer. One resembled a woman’s womb.

“He knew the place was bad,” Janice told me. “But he felt like he was in a nightmare.” He stumbled backward and rushed back up the stairs before any hospital staff could spot him.

Some power dynamics proved to be intractable, however. Diversity and representation helped, but they couldn’t erase the basic facts of their chosen profession. For all the tests, shocks, and surgeries performed, patients could still fall through the cracks and they were still no closer to a cure.

As I got a little older, though, I found out from family—not from my schoolteachers—that many never wanted to leave at all. That they often had less than twenty-four hours to plan their departure, and the stakes were not this-job-or-that-job; they were sometimes life or death. For these families, this Great Migration was not a careful and calculated choice—it was terrorism.

The state’s attorney, J. Albert Roney Jr., realized he had another carceral option. To the court, the three resistors were intractable. The Elkton jail did not have the power to force them to eat—but a mental institution might. Juanita, Wally, and Rose were taken from their cells and thrown into a police car with no notice, no explanation. One after another, they demanded to know where they were being taken. Finally, an officer replied. They were on their way to Crownsville Hospital.

“Anybody that will not eat and won’t stand up in court and plead acts like a mental case to me—and also to the State’s attorney.”

When they arrived at the hospital, Superintendent Charles Ward came out to greet them, rolling along wheelchairs to help bring them to their assigned rooms in the Medical Surgical Building. He wanted no part in this charade, but believed he had to show the state he was willing to do an evaluation. The very next day, he reported to the Cecil County Circuit Court that the Elkton Three were of sound mind and intelligence.

Black reporters saw clearly that the Elkton Three were being labeled as “crazy” not because they displayed symptoms of any genuine illness but simply because they had defied the expectations of police officers and white business owners.

All the Elkton Three did was pull off Route 40 to buy a meal. Their resistance was nothing more than seeking rest and basic human treatment. But they had crossed both physical and invisible color lines, and the punishment for that in the South was not just public shame—it was a portrait of insanity. Crownsville had become a weapon against those who dared oppose the existing order.

To put it simply: 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.

Wallace legendarily admitted that his political career took off after he focused on citizens’ fears of Black people instead of on infrastructural improvements to the state: “You know, I tried to talk about good roads and good schools and all these things that have been part of my career, and nobody listened. And then I began talking about niggers, and they stomped the floor.”

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.

when those Black patients then sought help, they were, at times, met by psychiatric professionals who were not only unable to relate to their lived experiences—they saw their illness as evidence that white doctors had been right about Black patients all along.

Metzl found that clinicians started to depict Black mental patients as threatening and uncontrollable, while white patients with the same illness were described sympathetically as “withdrawn,” nonviolent, and compliant. Suddenly, the rates of schizophrenia among Black men skyrocketed, and the entire image of the disease changed. The title of Metzl’s book came from a 1968 piece in Archives of General Psychiatry, in which two psychiatrists redefined schizophrenia as “a protest psychosis” that involved Black patients who had become hostile, aggressive, and developed “delusional anti-whiteness” after listening to leaders like Malcolm X or showing interest in the practice of Islam.

There’s also the challenge of the persistent myths and stereotypes that shroud people who live with mental illness. There is often the assumption that people with diagnoses like schizophrenia are the most likely among us to commit acts of violence and become hardened criminals. The truth is, they are far, far more likely to be the victims than the perpetrators.

A poem by a patient at Crownsville: And from the ashes the phoenix will rise to smite out the death that come from the skies. Genocide in Korea, Vietnam and the rest trying to prove whose nation is best. The blood on the ground all liquid and the red screams of the dying, the stench of the dead.

In the mid-1950s so-called wonder drugs arrived from Europe. And within a few years of their introduction to the United States, they were everywhere in public and private practice. Thorazine, the brand name for the drug chlorpromazine, was first synthesized by the Rhone-Poulenc labs in France in 1950. In 1952, the first American clinical trials began. By 1956, more than three thousand patients in Maryland’s system were being treated with the “new drugs,” and more than four million Americans were using them, too. Not long after Thorazine, other antipsychotics and antidepressants were pumped out onto the market.

In 1963, the push for community-centered care came to the forefront as United States president John F. Kennedy announced the Community Mental Health Act. For him, matters of mental health and disability were personal. His parents had kept the story and whereabouts of his intellectually disabled older sister, Rosemary, hidden from the public for years.

“Central to a new mental health program is comprehensive community care,” Kennedy said in a special address to Congress. “Merely pouring federal funds into a continuation of the outmoded type of institutional care which now prevails would make little difference.” In place of the old asylum model, he announced, there would soon be more flexible, locally accessible healthcare services.

Only a few years later under President Lyndon B. Johnson, the introduction of the federal Medicaid program doubled down on its displacement of the asylum.

Drug advertisements would argue that a community-based environment is a far better alternative to the old model of institutional dependence, and that drugs like Thorazine opened previously closed lines of communication between patients, clinics, and communities. But as the Elkton Three’s case shows, the state could still make inappropriate use of its various carceral apparatuses to detain the civil rights demonstrators in a way that was not consistent with a newfound focus on community or with the nationwide push to stop using the asylum as a receptacle.