Madness by Antonia Hylton review – how racism caused a mental health crisis in the US
aEarly in this heartfelt, deeply researched investigation into the history of mental illness among America’s black population, journalist Antonia Hylton describes a regular encounter with a close relative in a Massachusetts park. The family member – who did not want to be identified in the book – suffers from a very specific paranoia: they believe white supremacists are hunting them.
The relative, Hylton wrote, “covered all their windows with black tape… unplugged all their electronics, convinced they were being watched through every screen.” The worst part of it, she suggests, was that her lover believed that she as a journalist – a reporter at NBC – was a passive part of the conspiracy; that she had to call an editor and tell the story. “And in a sense,” she writes, “my lover was right.”
In part, this book is her detailed response to that cry for help. In exposing a century of neglect and incarceration of the disturbed and disenfranchised, Hylton reflects on the reasons why her extended family and the broader black community have suffered disproportionately from depression, paranoia and schizophrenia. Much, she argues, can be explained by poverty and injustice, the factors most likely to drive someone to a psychological breaking point, but there is also another striking fact: the perfectly rational fear that white supremacists are out to destroy them .
The terror of lynching in previous generations, Hylton suggests, has been replaced by the fear of police killings and by the mass incarceration of young black men. The rhetoric used by the far right to justify these actions has never changed much. In the years after emancipation, a series of commentators suggested, black people who were “immune to madness” while enslaved were psychologically ill-equipped for freedom. Fast forward to the present and the nation is primed for another election in which those old racist tropes about innate black self-destruction are fundamental to Donald Trump’s campaign.
The common thread through Hylton’s story is an institution called Crownsville, formerly known as the Hospital for the Negro Insane of Maryland. Crownsville opened in 1911, the hospital itself built through the forced labor of the first “feeble-minded” patients. At its peak in the 1950s, more than 2,700 people lived in a place that ‘existed on the spectrum of asylum, prison and warehouse’. It finally closed its doors in 2004.
Over the course of a decade of investigating Crownsville, Hylton has located and interviewed dozens of former patients and employees, and conducted forensic examinations of hospital records that had not been destroyed to hide decades of evidence of abuse.
Her many case histories show how people were sent to Crownsville for years for petty theft, or because of poverty or illness, and kept in close quarters with the criminally insane.
As Crownsville’s population grew, abuses increased. In 1943, a hospital employee revealed to the National Association for the Advancement of Colored People how patients were forced to eat rotten food and sleep on bare wooden floors. Children shared ‘wards’ with adults, where many patients were naked; ‘hydrotherapy’ was administered by nurses in starched white uniforms, in which patients were placed in very hot or ice-cold baths for long periods; electroconvulsive therapy was used, as in One flew over the cuckoo’s nestboth for punishment and treatment.
During the facility’s 93 years of operation, 1,700 patients who died in Crownsville were buried in a field on the facility’s grounds and nearly 600 other bodies were sent to universities for dissection. The makeshift cemetery is the site of a recent memorial and annual “Say My Name” ceremony, recognizing the forgotten dead.
As she tells this history, Hylton analyzes the psychology of race relations beyond the walls of Crownsville, not least in her own family history, where she shows how ‘inequality and racial violence (often) had the power to unravel cause and sow the seeds of mental illness.” There was Great Uncle Clarence, who fled his home for Detroit in the middle of the night after threats from the KKK, and who never recovered from the anger and bitterness. Or her father’s cousin, Maynard, who — after he started hearing voices — was fatally shot by a police officer in Mobile, Alabama, in 1976 while studying for his bar exams after graduating with a law degree.
Among these tragedies are some heroic stories of gradual progress. It took nearly half a century for Crownsville to hire its first ethnic minority staff member: Vernon Sparks, who in 1948 became the first licensed black psychologist in the state of Maryland. The beginning of integration, resisted at every opportunity, provided marginal improvement for patients in Crownsville. The first black nurse, Gertrude Belt, was the first to wash her patients’ hair; her friend Dorothea McCullers, a seamstress, made clothes for prisoners; and Marie Gough, now in her eighties, was the first to insist that patients could exercise outdoors.
These reforms were echoed in asylums across the country. In 1953, the National Mental Health Association invited all hospitals to dismantle and melt the remaining iron chains; from those handcuffs a symbolic £300 ‘mental health bubble’ was forged. However, when you read about how barbaric experimentation and effective segregation persisted, you recognize the legacy of those regimes in the woefully inadequate response to the current epidemic of mental illness, especially among Black Americans.
Hylton concludes her passionate and rigorous investigation with an analysis of the murder of Jordan Neely, the black homeless man killed on the Manhattan subway in May 2023 by former Marine Daniel Penny. Neely was characterized in the US as ‘unhinged’ and a ‘bum’ New York PostHis ‘crime’ is to confront passengers with words that echo through the centuries in Hylton’s history: ‘I have no food! I don’t have a drink! I’m fed up!” He was choked to death by Penny, an attack filmed by several commuters.
The same scene, Hylton argues, the “othering” of vulnerable black people as a way to justify violent and lethal control, has played out throughout America’s past. “The crises of mental illness, housing insecurity and income inequality negatively impact us all,” she concluded. “We can try to build cities and communities where this shame stays out of sight… but that will only become more difficult.”