Madness: Race and Insanity in a Jim Crow Asylum

by Antonia Hylton

Oral history is as old as any African and diasporic tradition, and a journalist or historian cannot accurately cover our communities without honoring and practicing it. At times, critics worry that the memory is unreliable, that spoken accounts are vulnerable to prejudice and influence. What source isn’t? Having spent countless hours reading the meeting minutes, letters, and musings of the state officials who controlled Crownsville Hospital’s operations, I can assure you the official, paper record is just as vulnerable to these forces.

And I felt more shame, because a not-so-secret part of me was wishing there was a place, an institution of some kind, where I could take my loved one for healing or rest or safety. A place where the experts would be wearing white coats but never gun holsters. A place where doctors would promise me that my loved one was safe, they were sleeping, and they were going to get the best of whatever treatment was available. But because I’ve studied the history of mental healthcare systems in the United States, I know such a guarantee never really existed. Not for my loved one, anyway.

feel compelled to write about the history of psychiatry and mental illness due to two forces: fury at the lack of services and support available in this country—particularly for the poor and people of color—and then out of pure, unyielding curiosity, as in both my personal life and in my reporting, I keep confronting this absence of help.

Out on my reporting trips I’m often overwhelmed by how many people I meet who tell me they cannot afford therapy or inpatient treatments that they know they need, that they cannot find providers who look like them or show respect for their personal and cultural experiences. I hear that their sick family members have had more interactions with the criminal justice system than they have with social safety nets or hospitals, and that the more stressors, poverty, and violence they are subjected to, the less empathy they seem to receive from their neighbors.

“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.”

I got hooked learning about the development of modern psychiatry. I saw for the first time the famous painting of French physician Philippe Pinel casting chains off of “lunatics” at the Salpêtrière Hospital in Paris, ushering in a new era of supposedly humane treatment for the afflicted and a modern, moral psychiatric movement. I read books like Michel Foucault’s Madness and Civilization and Birth of the Clinic, and studied signs of “shell shock” (now known as post-traumatic stress disorder) in soldiers returning home from World War I. I read every version of the Diagnostic and Statistical Manual and examined the gendered politics in advertisements for early psychiatric medications aimed at nervous 1950s housewives. I absorbed it all but, frankly, I wanted to know where the Black people were. What has happened to Black people when they, their families, or their communities went mad?

At the heart of Crownsville lie a couple of questions: What is the difference between calling a Black patient incurable and deeming a Black population certain of criminal recidivism? To what extent could this legacy be at fault for a current reality in which many communities of color feel alienated by psychiatric services and our prisons and jails are full of people suffering from mental illness?

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?

I tried to pay for his food but he wouldn’t let me. Secretly, I was grateful. I had no money and had funded parts of my research and meals by taking part in a series of psychology and neurology studies at Harvard, letting people prod and quiz me so I could get some quick cash.

The white attendants had no education and no training. In their short visit, they took note of three different patients showing multiple head and facial injuries. In each case, Dr. Winterode’s team insisted the patient had simply fallen. One patient called out to Tyus and his companions as they were leaving, begging them to get him out. He feared the guards would kill him.

Housed among the regular population were men who had been transferred to the hospital from the city jail and were allegedly criminally insane. There were detention cells, but with none of the proper hospital equipment. The young children housed at Crownsville were receiving no form of schooling or job training whatsoever. And there were widespread reports that some of the patients were being used “in abnormal ways sexually.”

Historian Jonathan Engel put it plainly: “The hospitals were breeding mental illness faster than they were curing it.”

Norton had discovered that Crownsville, the only place—public or private—willing to take in Black residents, had only eight doctors to take care of more than 1,800 men, women, and children, whom he described as being “herded into its buildings.” “Crownsville is supposed to do for Negro children what Rosewood Training School supposedly does for feeble-minded white children. But there is no school at Crownsville.” Men and women were sleeping in basement storage rooms and in sweltering attics without fire escapes. Children were two to a bed, sleeping feet-to-head. Some were overflowing out onto porches and going to sleep in rooms that had been designated for recreation. Children shared space with men who had been labeled as sex offenders.

In notes from the Mental Hygiene Board of Review’s meeting to discuss Crownsville in March 1954—more than a half decade after Norton’s exposé—board members discussed an area of the hospital commonly called “the cage.” The board described the cage as being a well-known isolated area for disturbed female patients. Hospital staff were keeping eighty women there, despite having sleeping space for only thirty-five.

Paul was drawn to the work of Dr. Thomas Szasz, a psychiatrist who forcefully argued that diagnoses were distractions from the root causes of why people are unwell. Dr. Szasz strongly opposed coercive psychiatry: he believed that mental health was an alienating and pseudoscientific concept forged by an Establishment that sought to control rather than heal. Like Dr. Szasz, Paul believed that illness was a logical response to poverty and societal trauma. That approach got Paul into some trouble in his early career, causing friction between him and other social workers who would eagerly toss around diagnostic categories. Paul preferred to think of behaviors as problems in living and coping.

As I got older, questions kept nagging at me. Was there a connection between the two: between living with the weight of that reality—striving to become somebody and to live defiantly in spite of it—and suffering mental trauma? Was Maynard really plagued by delusions, or was he refusing to keep quiet about the same pain and terrors that so many of our family members try to swallow whole? Were we all actually looking at the same set of facts about our existence and coming to very different conclusions about how to cope?

I asked Kendal how he’s found healing, how one finds their way out of the dark fog when tragedy and illness strike. He isn’t sure. “It still hurts the same way after all the years,” he told me. “But talking to you is helping me. It feels good to revisit. Isn’t that what you want? I don’t want it to not hurt anymore. It means I’ve forgotten something.”

According to newspaper reports and hospital records, everyone knew that the patients living in C were consumed by rage and resentment. Over the last two years, they had demanded better conditions. When improvements never materialized, they repeatedly ripped pipes from the radiators and walls in the dayroom, breaking infrastructure and sending water cascading down into hospital rooms, destroying mattresses, decks of playing cards, books, and shoes.

One night in 1953, some of the staff arrived to find that their colleagues had barricaded themselves in a bathroom. As they huddled inside, patients crowded at the door holding fiery newspaper rolls like they were tiki torches. They were attempting to smoke the employees out. Uria knew some of the men, and they had managed to survive that night in February 1953 by taking turns sticking their heads inside a toilet and repeatedly flushing it and gasping for fresh air.

the sad irony, of course, was that the reason Crownsville was struggling to hire enough staff and to run a safe hospital was, in large part, because the state was refusing to hire anyone who was not white. This straightforward truth seemed to go over the heads of many of its white neighbors, who wanted the hospital to spend its limited resources to fortify the hospital grounds. Meanwhile, Black Marylanders living in Anne Arundel and nearby counties were desperate for Crownsville, and many other state institutions, to desegregate. Many had tried to find jobs at the hospital for years, only to be met with disappointment. White residents’ commitment to segregation and employment discrimination was directly contributing to the hospital’s downfall.

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

It’s impossible for me to separate Idalia’s delusions from the reality around her. Afro-Cubans in neighboring areas were joining el Movimiento in large numbers, and they were eager for Castro to “see” them, to remake this nation and share it with them. Where there is violence, where there is resistance, there is paranoia. The police, at Batista’s orders, were cracking down and killing young militiamen. It’s estimated that twenty thousand people on the small island were murdered by the Batista regime, many in horrific and very public executions.

She died surrounded by lots of family. I was there, clutching her right hand. Her nurse, Tracy, told me that when a person dies, the last thing to go is their hearing. She might not have been able to feel me squeeze her hand or kiss her cheek. So I just sat there whispering in her ear, thanking her for every sacrifice she made, every hope and story she held on to for us.

So in 1953, when the National Mental Health Association asked asylums around the country to mail in any shackles or chains they’d previously used, Maryland leaders were eager to take part. It was a public declaration that restraint, fear, and incarceration would have no place in mental hospitals. On April 13 of that year, socialites and politicians, including Governor Theodore McKeldin of Maryland, convened at the McShane Bell Foundry in Baltimore. Together they melted down all of the chains and restraints received during the campaign and turned them into a 300-pound Mental Health Bell. It was a symbol or an aspiration, more than anything, that our society had progressed past a period of coercion and repression.

Marie discovered that her colleagues had allowed patients to walk and sit around in soiled clothing for so long that the floors had become covered in matted feces. None of her coworkers had warned her about the excrement she’d been walking in.

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

In a 1953 article, “Crowding of Youths at Crownsville Told,” the chief supervisor of social work at Crownsville, Gwendolyn Lee, noted that some of the overflowing patient population was not arriving of its own will. The hospital received “too many teenagers with no hope,” she said, and many of them arrived by force. Lee argued that there was “too large a percentage of cases where people are picked up off the street and taken to Crownsville without the knowledge of relatives… Less than 2% of the mentally ill are brought by relatives.”

“The great 1950s push for research in mental hospitals involved numerous human rights violations,” Paul wrote to me. At the time he arrived in the 1960s, staff were sometimes still offering patients cigarettes and candies in exchange for trying out new drugs.

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. In the archives, there are images of white nurses standing over Black men submerged below these thick, wet sheets. Employees explained that while the procedure might appear innocent, even calming, in photos, it could be incredibly uncomfortable and destabilizing. 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.

After more than three decades, Bill and Estella retired together in 1996. By that point, they were both a little disillusioned. They loved their teams and the life they had built together. Crownsville had put their kids through college and helped their family afford land in Anne Arundel. But budgets were slashed year after year. Patients were being sent out onto the streets to return to the “community,” although it seemed there was no plan for their continuing care. Bill had seen countless bodies—and Estella had worked with generations of kids, adults, and families. Estella knew it was time to go when they started to dread waking up in the morning.

For Faye, being asked if she found growing up inside an asylum strange is sort of like asking a person if they’d paid much attention to their breathing. That was life, and she wasn’t going to spend too much time dwelling on it.

Crownsville was still far from perfect; in fact, life as a patient was often heartbreaking and bizarre. What made the difference to Sonia was that she was being cared for by people who knew her and loved her and who never doubted that she had a future. She credits the Black women who wrapped their arms around her as having saved her life.

Politicians like Governor George Wallace of Alabama, the man who authorized state troopers to beat and detain civil rights protesters on that very bridge in 1965, famously reached office by amplifying the racial anxieties of white voters. 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.”

In January 1947 the unnamed author of an article titled “Why We Go Crazy” offered his or her admittedly nonscientific analysis for why so many African Americans were being sent to asylums. After noting that psychiatric experts had discussed the disproportionate rates of mental disease among Blacks, the author offered “a few contributing factors” for our consideration: Colored persons always come up on the short end of jobs and pay… They ride the rear seats of many interstate buses, trains and boats because an outmoded Jim Crow law is still on the statute books. Some stores in Baltimore refuse to serve them at all, while others take their money, but employ them only as broom pushers. They get the worst housing and pay the most for it. Merely sitting down and thinking about these and countless other things just as bad in a nation that is trying to sell the world on the democratic way of life could drive a lot of people crazy, and it probably does.

I believe that madness is part of all of us, all the time, that it comes and goes, waxes and wanes. —Otto Friedrich

during the 1970s and 1980s dozens of developmental centers, mental hospitals, and sanatoriums were converted to prisons, and that, in some cases, the annexation of mental hospitals into penal institutions allowed states to preserve union jobs that “were important to the financial welfare” of their communities.

The asylum became impractical in a community disinterested in institutional care for the mentally ill yet invested in the politics of crime and punishment.