Madness: Race and insanity in America
by Antonia Hylton
Footnote Press £20

HYLTON hopes her 10 years of research in archives and collection of oral histories which result in this book, will help to explain the roots of the broken mental healthcare available to African Americans, which fails them today as much as it ever did.

Her examination of the causes of mental illness in black Americans covers the brutality of slavery and continuing racism, bigotry and poverty.

The crisis of mental healthcare for black Americans is apparent from just a few glaring statistics: around 12 per cent of US citizens identify as black yet 44 per cent of homeless people are black, 50 per cent of adult prisoners and children in legal custody are black, as are 45 per cent of children in foster care.

Despite the stigma and shame about mental illness felt by many black people 25 per cent of them do seek treatment, but only 2 per cent of psychiatrists and 4 per cent of psychologists are black leaving these patients without culturally competent care.

In order to describe this historical journey she follows different strands which are seamlessly interwoven throughout the book.

Hylton draws on her own family’s history of episodes of mental illness. From her Cuban grandmother whose family supported the revolution, to her great-uncle, who during the Depression became President of the Macon, Georgia branch of the NAACP (The National Association for the Advancement of Coloured People) but following repeated death threats fled to Detroit.

The story of Maynard, the cousin of Hylton’s father who was shot dead in cold blood by a policeman whilst experiencing a psychotic episode is particularly chilling.

Central to this exploration of race and insanity in the US is the history of the facility established in 1911 as Maryland’s Hospital for the Negro Insane, the only one to be built by the forced labour of its own inmates.

Rising levels of mental illness in black communities since the end of slavery prompted the state legislature to introduce secure hospital provision with barred windows and locked doors — unless the inmates were working.

The official argumentation for this was: black people were happier under slavery as they were protected by their masters, they enjoyed working and the outdoor life. They were unsuited to freedom which made them lazy and lacking in direction.

The “treatment” was a regime of unpaid labour within an asylum and a system of loaning their labour out to local farmers and businesses, recreating a new form of enslavement, yet promoting it as “industrial therapy.”

After three seasons the asylum, rebranded as Crownsville, was a profit-making enterprise. By 1955 the number of inmates swelled to 2,719, in a facility built for 1,100.

Hylton’s painstaking research into the levels of mental and physical abuse, the dreadful living conditions, the deaths, the unauthorised drug experiments and lobotomies makes for a harrowing read, but is lightened to some extent by examples of individual kindness from staff who tried to mitigate the effects of the blighted system they worked under.

The criminalisation of black protest during the Civil Rights Movement of the 1960s led to an increase in convictions of activists who ended up in Crownsville — protests were seen as evidence of criminal insanity.

The line between jail and asylum became increasingly blurred as more prisoners were sent to Crownsville because the jails were full. So while the public mood was moving towards care in the community, Crownsville was firmly tied to Maryland’s police system.

Hylton says that by telling the story of Crownsville — closed in 2004 — she is honouring generations of mistreated patients, examining the absence of healthcare for black communities past and present and charting the fight for many more black professionals.