Journalist Antonia Hylton’s Madness: Race and Insanity in a Jim Crow Asylum critically explores the intersection between race and mental health in America. The Peabody Award winner (Southlake) focuses her lens on Crownsville Hospital, a psychiatric facility previously known as the Hospital for the Negro Insane of Maryland. Connecting former patients’ and employees’ oral histories to records from the Maryland State Archive, Hylton shapes Crownsville as emblematic of America’s fraught relationship with race and mental illness. Through historical and contemporary analysis, Hylton examines how racial segregation shaped the treatment (or lack thereof) of Black patients. In doing so, Hylton creates a space that amplifies the voices of those previously marginalized while advocating for reform for those grappling with lingering systemic oppression.
Crownsville Hospital opened in 1911 and was part of a broader national effort to segregate mental health care during the Jim Crow era. Hylton contests that the institution was a “literal cage…part of a statewide effort to maintain separation of the races at any costs.” Indeed, Crownsville’s history is marked by neglect, as the hospital was notorious for its horrendous living conditions, manual labor, and forced institutionalization. Most patients received little medical care or treatment, while many needed no treatment. One patient, Mr. Bell, was admitted for “the crime of being a Black man lost in the city with a foreign accent.”
Hylton unequivocally positions Crownsville’s purpose and services as extensions of slavery, rendering patients invisible, irredeemable, and incurable. From its beginning, Crownsville typified criminalizing mental health – endemic in the history of Black Americans and evident through the contemporary moment.
Her critique goes beyond recounting history or creating space for testimony. Hylton presents a scathing indictment of how Black Americans continue to be disproportionately affected by mental health stigmas, inadequate care, and systemic neglect. Hylton contends Crownsville “swallowed Black residents, the undesired, the poor, and nonconforming,” denying their health and humanity. Throughout Madness, Hylton traces the continuity of racial injustice from segregation-era institutions to present-day policies. In doing so, she reinforces the persistent failures to address mental health as a civil rights issue.
Hylton interweaves her own experiences with race and mental health, giving Madness a profoundly personal dimension. She reflects on being raised in a family where conversations about mental illness were often taboo despite seeing her relatives struggling with their mental health. Hylton’s narrative reflects the broader stigma that many Black communities face regarding mental health. This reluctance to seek help, rooted in historical trauma and distrust of the medical system, is a theme Hylton revisits throughout the book.
At one point, she looks beyond the patient to consider the medical community, specifically the availability of Black practitioners. She calls upon data from the American Psychiatric Association to show that “only 2 percent of the estimated 41,000 psychiatrists in the U.S. are Black, and just 4 percent of psychologists” (233). Given the history of medical experimentation and neglect endured by Black people, she extends the narrative to show how generations of Black families, including her own, have been wary of mental health institutions as patients and practitioners.
Throughout Crownsville’s history, some individuals fought for the patient’s well-being while challenging the racial and systemic injustices that permeated the institution. Among these were the reformers, often medical professionals, employees, and civil rights activists, who sought to expose the brutal conditions at the hospital. Hylton narrates the work of Dr. George MacKenzie Phillips, the first Black Superintendent (1964), who advocated for and developed better treatment for Black psychiatric patients. Or Betty Hawkins, former nursing director, who practiced the radical act of listening to the patients. In one example, a patient approached Hawkins and told her he didn’t belong in the hospital and to call his brother to verify his story. She called and soon learned from the brother that they thought the patient “was kidnapped or killed, but he was just waiting at Crownsville the entire time.”
These efforts for the patients’ well-being were often resisted since reform threatened the norms derived from maintaining segregation. Hospital administrators and government officials resisted calls for change and continued to obfuscate the truth. Yet individuals like Phillips and Hawkins exposed Crownsville’s inhumane conditions while advocating for medical and social reform. They demanded accountability from the state and the medical community, seeking justice and humane treatment.
Hylton’s writing continues Phillips’, Hawkin’s, and countless other advocates’ calls for mobilization. Madness is a call to action. Hylton urges systemic reforms that center racial justice in mental health care. This means dismantling the barriers that prevent Black individuals from accessing care, such as financial inequities, cultural stigmas, and the pervasive racial biases that still exist within America’s medical institutions. Her work is not just an examination of a cultural history. It is a clarion call for creating a genuinely equitable mental health system.