Madness: Race and Insanity in a Jim Crow Asylum

by Antonia Hylton

When we learn about the global history of mental healthcare and the birth of institutions like the asylum, Black patients are conspicuously absent from the history books, excluded from the narrative of recovery. Nowhere is this truer than in the history of Maryland’s Crownsville Hospital for the Negro Insane. Founded in 1911, Crownsville Hospital was one of the few American segregated asylums with surviving records. During its peak years, it held 2,657 subjects, and for decades served as the only mental hospital in the State of Maryland that would accept Black patients.
 
In Madness, Emmy award-winning news correspondent, Antonia Hylton explores Crownsville’s history and how the legacy of slavery and racist stereotypes ultimately pave the way to the criminalization and stigmatization of Black patients. Madness is using journalistic investigation, photographs, original research, interviews, primary sources, and newspaper records to raise questions about our country’s incomplete narrative. Hylton beautifully moves between anecdotal accounts from within Crownsville and wider-lens perspectives on how it shaped the legacy of care and empathy for Black people. She connects the aftermath of chattel slavery to Crownsville, where patients were also forced to work the land. She explores treatment from the medical staff and the fearmongering in surrounding neighborhoods. And she examines the state of our broken medical healthcare system of today. Above all, Madness provides deep context on who is considered redeemable, centered on those receiving the worst of what is available.
 

Genres: Nonfiction, History, Mental Health, Race, Audiobook, Psychology, Social Justice

329 pages, Kindle Edition

First published January 23, 2024

About the author

Antonia Hylton is the author of MADNESS: Race and Insanity in Jim Crow Asylum. She’s a Peabody and two-time Emmy award-winning Correspondent for NBC News and MSNBC and the cohost of the hit podcasts Southlake and Grapevine.

From 2016 to 2020, Antonia was a Correspondent and Producer for Vice Media and HBO’s nightly news and documentary show, Vice News Tonight. Since 2019, she has also served as an annual judge for the American Mosaic Journalism Prize.

Antonia’s won several awards, including an Emmy for the HBO special episode on the family separation crisis, two Gracie Awards for her stories about women, a NAMIC Vision Award for reporting on violence and politics in Chicago, and two Front Page Awards for special reporting and breaking news.

Antonia graduated magna cum laude from Harvard University in 2015, where she received prizes for her writing and investigative research on race, mass incarceration, and the history of psychiatry.

Reviews

[Jenna ❤ ❀ ❤ · Rating 4 out of 5]

If you know anything about mental health treatment in the past, you know it was anything but humane. Mental hospitals, asylums, were horrific places.

No surprise that the Crownsville "Hospital" for Black people in Maryland in the 1900s was even worse than asylums that housed white people. The first patients even had to clear the land and build the place!

This book is infuriating, learning how these people were treated. Unfortunately, not a whole lot remains of the records of individual patients and the author is left relying mainly on ex-employees of the place for her book.

I would have preferred to read more about specific patients but it's not the author's fault that the records were scant to begin with and many later destroyed. She did piece together a very readable account with what evidence she had access to and through talks with those employees, one of whom had also been a patient.

At times the narrative jumped around which was annoying but it's still a very worthwhile read.

[Kristine · Rating 5 out of 5]

The Best Non-Fiction Book of 2024! Read This February for Black History Month

My first thought reading this book is, Why can we not extend ourselves and do the right thing? It is just that simple. Leaving our most vulnerable to struggle in an Asylum and trying to forget these individuals are people with feelings, need for community, safety, and peace is wrong on every level. This book examines Crownsville Institute. It is extremely well written and researched. It is also clear the author has much empathy and compassion for this important story.

Crownsville Institute only black people went to. It was located in Annapolis, Maryland which I did not even know operated under Jim Crow Segregation. State Mental Hospitals have a long history of very questionable practices. So, now add in rascism, lack of funding, overcrowding, and initially the staff could only be white. How could this possibly work out well? It is doomed to have severe problems. These are obvious. When the staff doesn’t know or understand the population they are caring for, this is a problem. When we mix individuals from jail, the homeless, the severely mentally ill, the displaced showing mild signs of mental distress, individuals with disabilities, and children we have a serious problem. That is a given, yet it was done. Experimenting on patients without their knowledge or consent causes fear and mistrust. Using the Negro Hospital as a dumping ground for all sorts of problems and the staff must take that person as I patient will not create good results. We hurt, each and every person when we dehumanize them and just try to look away.

I applaud Antonia Hylton for writing this book. It deeply affected me and was disturbing. She has a family member with a serious mental illness. I understand this since anxiety and depression run in my family as well. That is enough to have to struggle through. If you are fortunate, you have family able to carry much of the caretaking and oversight. If you are not, you are probably not going to have a good outcome. This is too much to ask families to carry alone. We must admit the damage afflicted toward black individuals. Most have had to navigate a way of life that does not expect much success to come their way. Now, if you are sick, you add a serious additional hurdle that many just can not overcome. It hurts communities, it hurts society, it hurts our basic dignity.

We owe the mentally ill, and this addresses black individuals, much better. Care and healing must be our goals or do not be surprised when these communities have absolutely no trust in doctors, therapists, or anyone claiming they can help. No one who sees such injustice over generations is going to easily think their well being is a priority. This is shameful and it cuts the ability of many who could strive and bring incredible success to the United States. We must do better, starting immediately.

I read books like this to stay informed. If I don’t know the past history, how can I possibly even suggest solutions? I felt for so many of these individuals. It was quite clear Ms. Hylton is trying to be fair and give informed information. She is trying to bring the complete story out including many employees that cared deeply for some of these patients. Black people working at the institution were in a better position to understand the people living at Crownsville, some for decades. She does not have an ax to grind or not credit those who made contributions. She does one outstanding job with a difficult story to tell.

May we read and learn from our mistakes and have decency and kindness finally prevail. It will make each and every one of us feel proud and know we stand behind those struggling with an illness or sometimes just a different kind of personality. Our overall thinking must change and there is a need to strive for excellence. We need to listen to those who know this population and of course ask the individuals their needs. This goes a long way.

Thank you NetGalley, Antonia Hylton, and Grand Central Publishing for a copy of this book. I always leave reviews of books I read.

I would not be surprised if this book was selected for a Pulitzer Prize for Journalism. I think it certainly deserves to be selected. It is that good and moving.

[Montzalee Wittmann · Rating 4 out of 5]

Madness:Race and Insanity in a Jim Crow Asylum
By Antonia Hylton
This book not only details some of her families issues of obvious discrimination and lack of service availability. This goes back in history and mainly focuses on the first black asylum in Maryland. It's an eye-opener if you have never read about asylums in the past, but for a black asylum, it was virtually a prison with free labor.

[Erin · Rating 4 out of 5]

4.5 Stars!

Madness is the harrowing story of not only one of the last segregated asylums in the U.S. but also a look at how the mental health of Black people has been mistreated for decades.

Crownsville was located in Maryland as the only mental hospital to serve Black patients and it was a substandard institution from day one. Racism in healthcare was and still is a huge problem. Madness shows why we need to view healthcare as a civil rights issue.

I can't say I enjoyed this book but I did learn alot. Antonia Hylton is a masterful truth teller. I can't imagine how hard all this research was to conduct. Every review I've read calls this book a revelation and I whole heartedly agree.

A Must Read for Everyone!

[Liz · Rating 5 out of 5]

Madness, written by Antonia Hylton, tracks the 93 year history of Crownsville Hospital, a segregated mental asylum in Maryland. I had a particular interest in this history, having lived in Maryland for many years, including a few in Anne Arundel County. But also, it’s so apparent that our society has consistently failed those with psychiatric problems.
Maryland never seceded during the Civil War, but it was definitely a southern state when it came to attitudes towards Blacks. The hospital was the only one ever built using the labor of its patients. And throughout most of its existence, it relied heavily on the “free labor” of its patients, both on site and being hired out to local farms and businesses. In part, it was forced to do so because the Maryland State government allocated so few financial resources to the hospital, especially compared to white facilities. But it also used this “free labor” or industrial therapy as they called it in the mistaken belief that Blacks responded better to different “treatments” than whites. Even in the late 1950s, when a report indicated the need to update all the psychiatric hospitals in Maryland, Crownsville was allocated less than half the amount per patient given to white facilities.
For decades, the hospital was poorly staffed, especially by doctors, and attendants were barely trained. The staff was not integrated and finding whites to take care of Black patients was an issue. Violence against the patients was the norm, as was enforced isolation. There was little segregation of the violent mentally ill patients from the general population, including children. Even patients with tuberculosis were housed with the general population.
Hylton does an excellent job in describing how the living conditions of Blacks (police violence, lynchings, poor job opportunities, Jim Crow laws) led to higher rates of paranoia and depression. Is it paranoia if what you fear actually exists? A 1947 newspaper article “Why We Go Crazy” spelled it out perfectly. She also shows how decade after decade, the police, courts and governments placed homeless, “unruly” or difficult Blacks in asylums. In the 60s, the Elkton Three showed that protesting a lack of civil rights could land you in Crownsville. “Crownsville had become a weapon against those who dared oppose the existing order.”
As with other aspects of medicine, patients were sometimes unwillingly subjected to testing. And as the move to deinstitutionalize started with the advent of psychiatric drugs, the patients of Crownsville also fell through the cracks.
As you would expect, this is a deeply disturbing and depressing expose. But it’s one that needs to be read as it raises important issues.

[Veronica Flowers · Rating 3 out of 5]

I assume I am not like most readers on here as I am well versed in the history of psychology. As such, I found the book both important and disappointing (if I am being honest). It is important in that most people do not have an understanding of the history of asylums and how that has led to the current disgraceful state of mental health in the U.S. (which I say as a provider in the system) and the history of race relations that has been far beyond disgraceful. The author does a great job putting race into context, especially for readers unfamiliar with this history. What I found disappointing, however, was the way the book was written, which felt uneven. Some stories drew me and I found myself flying through the pages, only to come to an abrupt shift onto a different topic without a clear understanding of their connections. The organization felt haphazard. Some of the areas were much less engaging, and I found myself struggling to maintain interest. This may make it difficult for non-academic populations, who are the ones who could probably most benefit from reading this history. I also sometimes questioned the author's judgmental statements- the facts can speak for themselves without adding an unnecessary layer of opinion. The opinions were abundant; the facts less so. I was deeply interested in the author's methods of research and would have enjoyed more narrative regarding how the information was uncovered. In summary, an important book that I did not particularly enjoy. If it had been approached and edited in a different manner, I think it could be even better. However, if someone were interested in this topic, I would still encourage them to read it and I applaud the author's efforts to focus on this topic.

[Fergus, Weaver of Autistic Webs · Rating 5 out of 5]

Some things are better left unsaid. Normal people accept that fact.

But to a bipolar Catholic like me, in grateful medicated remission from its reverse - a delusional sorta paranoid behaviour - I, and the author’s “loved one”, know whereof we speak.

Racism is not uncommon throughout America. And even within loving families, bullying tendencies can be real.

Psychosis has its surreal foundation in reality.

***

Ms Hylton has written a stunningly self-revelatory masterpiece!

***

Even from the word Go, you know this book tells it all about our shared illnesses.

Every night, saying my prayers, I mentally repeat the words “mourning and weeping in this vale of tears” as if I had written them myself.

Life has real thorns.

And some - like the two bases of our delusion I mentioned - draw real blood.

And untreated wounds can become infected or introjected.

And even though we can thank God life is so good -

A large part of it is not!

[Megan · Rating 4 out of 5]

A great work of investigative journalism, Antonia Hylton’s Madness: Race and Insanity in a Jim Crow Asylum is by equal measures incredibly engrossing and expectedly unsettling.

Hylton talks her own familial struggles with mental health issues: the hard truths and the painful realities she encountered before and during the writing of this book. It allows for her to come across as a very sympathetic author, speaking with compassion and concern on a difficult and sensitive subject.

When one considers how horribly the United States has historically treated mentally ill patients (especially those institutionalized) in the early and mid 1900s, it’s not difficult to imagine just how much worse black patients had it. Even with that in mind, so many of the individual stories are downright heartbreaking.

So many of these patients did not suffer from any type of demonstrable mental illness whatsoever, but were simply locked up in asylums because they had been a “nuisance” to white communities at any given point. The ones that were truly ill and in need of comprehensive treatment were at best ignored and at worst, restrained to the point of abuse, or in some cases, forced to undergo electroshock and lobotomy “therapy.”

The lucky ones were the ones who had supportive and loving families, that made sure they knew they were wanted and loved. Those are the patients that made it out. Many others never did, and in the worst cases, some had been placed inside the Crownsville facility with their families never being informed. Some instances are particularly harrowing:

”Betty Hawkins …did what she could to get patients she felt didn’t belong there released. One afternoon, a patient in the HY Building approached one of her student interns in desperation. For some time, this patient had been begging for any and everyone to listen. He said he didn’t belong in an asylum…but no one had taken him seriously.

The patient gave this student a phone number and address of his brother, who he said lived in Washington, D.C. and begged them to call. Betty Hawkins discovered 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 in Crownsville the entire time.

Betty notified the necessary administrators of the ‘mix-up’ and got him out. That patient wasn’t the only one. Another patient Betty worked with had been at the hospital for twenty-seven years. After worrying about how isolated this patient had become, Betty contacted their relatives in Baltimore. The family was in shock. They, too, had no idea their loved one was there…for twenty-seven years, they had assumed the worst.”

I think it’s pretty much a given that if the staff is so understaffed and overwhelmed that they wouldn’t even bother to make a phone call on a pleading patient’s behalf, then any real standard of care would be absent. Fortunately, Hylton does speak of nurses like Betty and other black staff who did their best to make a difference when and where they could. The advent of more black staff allowed more positive outcomes like proper care and discharge home to their families to occur.

My only real complaint(s) - and thus the four stars - was that a disconnected narrative often didn’t follow a linear path - something I believe would have been preferable for a story taking place over the course of nearly a century. Also, for as long and as well-researched as the book was, Hylton doesn’t organize her sources as neatly as she could have, and at times, I didn’t see a source at all, which made me wonder if conclusions hadn’t been drawn too quickly in order to save time.

An example of this would be on p. 111, when she surmises about a woman’s pregnancy and if the stressful birth may have contributed to the premature death of the child, to which the woman said she had no way of knowing. The problem here is, the baby was already three months old. It’s already mentioned the cause of death as pneumonia (aligning with the fact that the woman and her family lived in a shack with no heat during a freezing cold season).

I know, I know, I might sound like I’m being too nitpicking here, but if the storyteller herself doesn’t mention this as the cause of the tragedy, and a very plausible explanation exists, then I just don’t understand the need for further speculation.

I could write a lot more on this, but I think I’ve gone on long enough. :) I definitely recommend as a must-read book. For it is the very true and painful experiences found within Hylton’s book that allow white readers to gain a better understanding of how horribly unjust things truly were for blacks in a segregated community. I hope to see more from this author in the future.

Sorry for any errors… I’m tired. 😴

[Joanie · Rating 5 out of 5]

Had the opportunity to read the book early.

It is gripping, illuminating and heart breaking.

The author achieves the feat of presenting a piece of work that is an extremely well researched account of history that is also deeply personal.

I love a book that helps me learn or that makes me feel, and this book does both.

It’s an important book covering a grossly undercovered topic, and I was glad to find it an enjoyable, digestible read at the same time.

Strongly recommend!

[laurel [the suspected bibliophile] · Rating 5 out of 5]

In a country built upon systemic racism and white supremacy, what constitutes sanity among the subjugated classes?

Madness is a heartbreaking and crucial read of the history of mental illness (and much misdiagnosis) and racism in segregated asylums.

The book covers the injustices and horrors of Crownsville, but sparkled amongst the pain are stories of people doing their best in to do right and protect the humanity of their patients against overwhelming odds, and those working tirelessly in the years after Crownville's closure in 2004 to identify, remember and honor those who were lost.

[Stephanie Dargusch Borders · Rating 3 out of 5]

There’s definitely a fascinating story here—the style of the narrative wasn’t for me. I never caught on to the thread of what Crownsville was all about. Instead I struggled to follow and connect.

[Reginald Williams · Rating 5 out of 5]

Hylton’s “Madness…” is superbly researched and wonderfully written.The interviews and anecdotes especially make this a vivid contribution to building a true History of America from the ground up.
Day-to-day lives of African American patients / detainees are provided context by the daily lives and struggles of Black people in Maryland /Washington.
Hylton weaves in the frayed thread of her own Family’s struggles with mental health issues.
These pieces portray the human face of Black people’s psychological suffering that are woefully unknown for the most part. It also personalizes the horrors of the Jim Crow system.
This book should find its way into the curricula of every high school through university. Thanks for This.

[Quinetta · Rating 5 out of 5]

This book was such a difficult read…not the quality of the book but the content. The information provided was so eye opening but also sad because of the disparity in mental health services and care between the different races. Crownsville hospital began with such evil intentions and so many tried to change the environment over time but white supremacy is so insidious and hard to get rid of that when you mange to do so…it’s too late. I encourage everyone to read this book, confront the realities of the availability of mental health services over the years, how it’s dealt within familial spaces and how it’s handled within the black community.

[Haley Nicole · Rating 2 out of 5]

2.5 stars

This story is SOOO important. Everyone should know about this.

My problems with the story had to do with the way the book was written. It was hard to follow and often brought up individuals names from multiple chapters back. The book did not flow well which made it hard to read at times and finish in a timely manner.

[Em · Rating 5 out of 5]

Antonia Hylton's "Madness" takes readers on an eye-opening journey through the haunting history of Crownsville Hospital, one of the last segregated asylums with surviving records, in Anne Arundel County, Maryland. With meticulous research and a deep emotional investment, Hylton brilliantly uncovers the 93-year-old history of this institution, providing a vital perspective on the intersection of race, mental health, and the enduring legacy of slavery.

"Madness" serves as a vital resource for readers seeking a comprehensive understanding of the history of mental health treatment in America from a Black perspective. Antonia Hylton's eloquent storytelling and her unyielding commitment to shedding light on the dark corners of mental health history make this book a must-read for anyone interested in the intersection of race and mental health. Hylton chronicles the stories of Black families whose mental health was profoundly affected as they struggled, often in vain, to find safety and support. What makes "Madness" exceptionally powerful is Hylton's personal connection to the topic, as she reflects on her own family's experiences with mental illness and the secrecy and shame that lingered for generations. Her ability to intertwine her own story with the broader narrative adds a layer of intimacy and authenticity to the book.

Hylton's meticulous investigative research and archival documents bring to life the experiences of patients and employees at Crownsville Hospital. By sharing personal accounts from patients who are still alive, she lends their voices the platform they deserve. Through the poetry, testimonies, and artwork they left behind, the reader is given a rare glimpse into the emotions and experiences of those who were silenced for far too long.

"Madness" also explores the deeply ingrained racism and stereotypes that have persisted in the American mental healthcare system, tracing these issues back to the legacy of slavery. Hylton masterfully exposes how these prejudices have led to the criminalization and stigmatization of Black patients in present times. Her narrative is a compelling testament to the necessity of reframing the history of psychiatry from a pro-Black, affirming perspective, shining a light on important pioneers in the field like Dr. Tami Benton, who play a crucial role in rewriting the narrative of mental health treatment particulary for Black children and adolescents.

Hylton skillfully connects the dots between America's history of mass incarceration and the expansion of prisons and the process of deinstitutionalization, unveiling how these issues are inextricably linked. Thank you to the author and publisher for the e-arc copy!

[Meredith · Rating 5 out of 5]

I absolutely cannot wait for the rest of this book! What an incredibly tragic glimpse into the world of mental health, mental illness and the horrors endured by the African American population during the early 1900s. Before this excerpt I had no idea that Crownsville existed but I now intend to read everything I can find about the institution. Thank you NetGalley for the opportunity to read this!!! I can already tell it will be a 5star read for me!

[Bobbieshiann · Rating 5 out of 5]

A MUST READ! I will be rereading it again in a few months. Thoughts will be added then.

[Amy Biggart · Rating 5 out of 5]

excellent

[Alise · Rating 5 out of 5]

This was such an engrossing read. As someone with family a small drive from Crownville, MD, I've been aware of the existence of Crownville but not the history until now. Once I started reading this, I couldn't put it down. I finished this in less than 24 hours. We tend to think of the past in such a distant way. Crownsville State Hospital closed during my lifetime (probably the lifetime of anyone reading this as well). Interviews with family members of former patients and with former employees, along with historical archives saved at the last minute have culminated in this amazing work.

It not only tells the history of the asylum but also discusses the history of mental health treatment, institutions and the continued failures of both asylums and community care. It discussed the criminalization of mental health policies and the increased carceral response to poor and mentally ill community members. Something that strikes me most was a portion in which someone interviewed discussed they were running out of time to tell this story as those who lived it were passing away. How much of our lives and history are loss because there is no one to carry the story? What stories are we carrying? I expect that this is a read I will revisit in the futures.

Disclaimer: I received a free finished copy from the publisher in exchange for an honest review.

[Becky · Rating 5 out of 5]

This book was incredible and maddening and completely unsurprising. I went into this book prepared to be completely heartbroken and filled with justified rage on behalf of the people who were mistreated at this asylum, and there was definitely a fair bit of that... but by the end, I found myself sad that it closed. Something that had started out so horribly had eventually been transitioned into a much needed resource in the community.

I was honestly so engrossed in the history and stories of this asylum, I was sad when it was over. Hylton's research was excellent, and tying in the personal stories of faculty and patients, as well as her own family history, really made this an excellent read. Highly recommended.

[Rob · Rating 4 out of 5]

Antonia Hylton does a great job laying down the 93 - year history of Crownsville Hospital, one of Maryland's only segregated asylums. She uses what documents were finally allowed to be reviewed and oral histories taken during the pandemic mostly by zoom calls.

However, there's really nothing new here - just another place and time when Racism rears its ugly head.

[Gabriella · Rating 5 out of 5]

Actual Rating: 4.5 stars

This was so impressive, considering how many different topics Antonia Hylton takes on—family history, medical history, organizational/institutional history, and attempting to draw the dots between our past and present forms of mental health “care.” Expect lots of "fun" facts along the way—I had no idea Pauli Murray’s dad and Henrietta Lacks’ daughter were both at Crownsville! Then, expect these “fun” facts to turn into heartbreaking stories about just how poorly people were treated in Maryland’s only Black asylum.

Humanizing personal elements
Like I noted earlier, Madness is partially a history of Hylton’s familial experiences with mental health. She shares about her own experiences trying to help relatives grapple with their illnesses, and she attempts to unearth the stories of relatives earlier in the family tree. In so many Black families, these stories are intentionally hidden away, so sharing about them is really important. I also appreciated the inclusion of these stories, as they helped to show just why this topic was so important to the author. In many academic and/or investigative books, the personal connection to the subject matter is obscured! Instead, with Madness, we see an author who is personally driven to investigate just how few options there are for her loved ones to receive help in ways that don’t re-traumatize them:

“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.” (2)

As someone who has been closely involved with a relative’s mental health crises (including multiple hospitalizations), I really admire Hylton’s candor here. She also shares this information while also respecting her living family members’ desire for some anonymity, which is equally important. And in each personal story, you clearly how the political realities of the world drove Hylton’s relatives to the brink (more on that later.)

Anyway, Hylton’s reflections on the role of Black staff in Crownsville also felt personal to me. My maternal grandparents, who grew up less than an hour away from each other in North Carolina, didn’t meet until they were both working at Greystone Park Psychiatric Hospital in New Jersey. While Greystone is different from Crownsville, I imagine its Black staff had some similar experiences to the ones in this book. Because my nana passed when I was 8, and my granddad before then, I never had any conversations with them about their time there. But, after reading Madness, I am much more curious about how many Black people were tasked with this sort of work in the postwar period.

Emotional range and madness and us idolizing “productivity”
Not to keep bringing Love In a Fucked-Up World into everything, but Dean Spade really made (synthesized?) some important points!!! During a recent close read with book club, many of our reflections were about how our emotional range has been limited due to the production-obsessed systems we live under. To be a “productive” individual in a capitalist world, you often have to ignore all of the horrors and injustices of our world, and just keep plugging away at work/school/life. This sort of ostrich mentality limits our emotional range for the sake of “functioning”, and it also makes us incredibly uncomfortable with people with wider emotional ranges. As you’d expect in such a punitive society, our discomfort with these people with wider emotional ranges results in us seeking all sorts of ways to punish them—including, of course, psychiatric hospitals.

This, I found, is where Hylton comes in!!! One of her main arguments is that many of the people forced into Crownsville were actually the people are being honest about the pain we are ignoring to go to work each day. In other words, society was making people mad, and then punishing them for being mad!!! Work and productivity was CONSTANTLY used against the Crownsville patients, including when they literally were forced to build their own hospital to “cut costs” on the construction!! What’s more, Hylton showed several cases that indicated the slippery slope of sanity. For most of Crownsville’s years of operation, any Black person could be sent to Crownsville for simply being in the wrong place at the wrong time—let alone for expressing the wrong political opinions or beliefs!!! So basically, all of this is tied up with control and societal ills—not actual mental health care.

The lack of care is everywhere
Okay so again, Hylton said that she wanted to write this book because of her “fury at the lack of services and support available in this country”, since “in both my personal life and in my reporting, I keep confronting this absence of help.” (3) Again, I can certainly relate to seeing how scarce truly impactful mental health care really is in our society. Even if you can get into a quality inpatient program after months on the waitlist and thousands of dollars above what insurance will cover, you may not be able to access follow-up treatment once you must get back to your life (and of course, work.) Madness really helped me understand the root of this scarcity, which is that when they started closing down places like Crownsville and kicking people out of the asylums, no comprehensive mental healthcare system was ever fully built to replace it.

Of course, we had lots of half-measures, such as the growth of psychiatric medication in the mid-century (I previously learned about this in Patrick Radden Keefe’s phenomenal takedown of the Sackler Family, Empire of Pain.) There was a push for community healthcare, with more localized and less massive institutions to provide a combination of inpatient and outpatient treatment. However, as Hylton notes “Community healthcare, of course, rests on the assumption that there is a community that will welcome someone home.” (231) The model almost immediately failed in places where people were deprived of medical care and communal connections—Hylton describes how twentieth-century displacement in Annapolis and Baltimore created this reality for many Black families who had loved ones at Crownsville. Basically, just like there “wasn’t money” to build or operate Crownsville, there “wasn’t money” for the community mental clinics they wanted to replace it. 😭

And of course, this leads us to mental aslyums as the missing link to where we are today. Because as Hylton notes, at the same time that many states were getting rid of asylums, they were building LOTS MORE PRISONS. Sometimes they just flat out CONVERTED ONE TO THE OTHER, as she descries in several cases!!!! As she notes, Crownsville’s predominantly Black patients particularly suffered from this transition from one form of containment to the next. In addition to the huge overlaps in policing, Crownsville often offered as a partial form of respite for other Black residents suffering from our society’s dearth of care. For instance, Hylton shared staff’s accounts of how many unhoused people would voluntarily admit themselves to Crownsville in the winter because it was too cold to be on the street, and no one was offering them a home. As bleak as this picture is, unfortunately it got even worse after Crownsville closed, when many of the former patients became unhoused in Annapolis or Baltimore.

Asylums and the PIC and slavery
Okay so I’ve already kinda talked about this, but basically Madness makes a very clear argument for the asylum as the missing link between the past and our current era of mass incarceration. Hylton speaks most clearly about this transition on page 267:

…why it was that the prison—and not another social support or institution—suddenly became the chosen receptacle for America’s surplus people and social ills. It was the asylum, not the prison, that had long been America’s mammoth institution. In 1952, less than 150 per 100,000 people were incarcerated in state and federal prisons, while over 600 per 100,000 were living in some form of asylum…while the story is nowhere near as simple as one institution morphing into the other, it is no coincidence that the end of the twentieth century marks both the decline of the mental hospital and the expansion of the prison system.

As we unfortunately know, the legacy of anti-blackness in the asylum context is alive and well in modern prisons, where most people have mental illness. Like with Crownsville’s patients, many prisoners are subjected to terribly strenuous labor for little or no payment. I buddy read this with my friend Adriana, who remarked upon the similarities between Crownsville patients’ forced labor and the modern situation with incarcerated firefighters in California, who are often ineligible for civilian firefighting jobs after being released, despite having already performed this lifesaving work. Crownsville’s administration similarly failed to upskill or provide accreditation for the work done by their patients, making it clear that all their skills were only in service of the institution.

Hylton shows that the administration’s terrible labor practices came from another thing we are very familiar with today: conservative demands for “government efficiency.” Crownsville serves as a key example for why market-based narratives are deeply damaging lenses through which to evaluate public service provision. After all, when the State of Maryland decided it didn’t want to fund the Black asylum, Crownsville’s administration literally decided that the best way to “cut costs and be self-sufficient” was TO ENSLAVE THE PATIENTS AND LEASE THEM OUT TO COMPANIES. I cannot help but fear that this is the end game of so many of our current policies…AGAIN.

Hylton mentions so many other links between the expansion of the prison industrial complex, the psychiatric institutions, and slavery. There were literal slavecatchers sending random people to Crownsville for a monetary fee, portrayals of Crownsville patients as “escapees” that could revolt at any time, and plans for a literal juvenile detention center on the Crownsville campus. Let’s just say, this is a really important link in this book.

Final Thoughts
This is just an incredibly impressive view of a sobering topic. I can’t imagine that many people would read this and not find some part of the history that speaks to their current reality. Would highly recommend!!!!

[Deacon Tom (Feeling Better) · Rating 4 out of 5]

Incredibly sad but true to the times

[Teri · Rating 4 out of 5]

Originally known as the Hospital for the Negro Insane of Maryland and opened in 1911, Crownsville Hospital Center was built on the backs of the very men and women who were housed within its walls. Opened with just 12 patients, the center was a work camp by day, constructing buildings on the campus and working fields of tobacco and other staples, and a hospital at night that mistreated the patients, who were primarily people picked up off the streets. The hospital, located just outside of Baltimore, Maryland, was a Blacks-only institution with little funding and often understaffed personnel who rarely cared about its patients. Because it was a segregated hospital, the management could not attract skilled doctors, nurses, and staff. So those who worked there rarely knew what they were doing and didn't care. Eventually, the hospital would swell to nearly 3,000 patients in 1955 before closing in 2004.

Journalist Antonia Hylton chronicles the history of Crownsville and racism, discusses mental illness, and relates the effects of the disease in her own family. The history is told through stories and first-person narratives of people who worked and were housed in Crownsville. The stories are sad and infuriating. Many patients were either treated as specimens in medical trials or were subjected to cruel and unnecessary treatments. A large portion of those housed at Crownsville were perfectly fine. The hospital was, at times and for some, another form of slavery.

This is a well-written and well-researched case of injustice.

[Karen Burbank · Rating 3 out of 5]

This is an important topic and a ton of research was obviously done but the narrative got bogged down and I sometimes had a hard time following it.

[George Stenger · Rating 3 out of 5]

I read this for a book club that is meeting today. I will recommend it to a social justice book club.

This book covers a lot of topics from Jim Crow (racism) in the north. In addition, it discussed extensively the amount of people that were previously treated at mental health facilities were later incarcerated in prisons because there so many of the mental health facilities were closed.

There are many sad examples of people were caught in this system. Many people were sent to the mental health facilities because their families wanted them to be sent away or the jails were full or the police did not want to deal with them.

The book provided some excellent information but was choppy to try and follow at times. The author provided a lot of facts but many times she added her opinion that lessened the facts.

A worthwhile read. The Woman They Could Not Silence by Kate Moore is an excellent book. It doesn't cover the racism aspect but clearly showed the ability of family members to have other family members committed solely based on their recommendation.

[Angyl · Rating 5 out of 5]

Extremely informative and well researched history of Crownsville State Hospital which was opened in Maryland as the first black only psychiatric facility. Antonia covers everything involved with the facility from its construction in 1911 to the inevitable close in 2004. Antonia also seamlessly blends her own family history with mental illness into the story as she examines the stigma around mental health and poor treatment of individuals in state facilities, taking a close look at the role segregation and racism plays.
Highly recommend!

[Angela Christopherson · Rating 3 out of 5]

Continued Racism

The research is impressive and educates many, such as myself, that had no idea of the cruelty, however; I see prejudice displayed throughout the book in such that Black is written with a capital letter but white is all lower case. How are we ever going to get past the hatred for each other if little things such as how a word is written continues to act as a dagger to others? It's terrible that the historic government allowed people to be treated so inhumanely but to continue to cut each other with words and actions, insignificant as it may seem, will only prolong the resentment and prevent healing and love to prevail.

[Kenzie | kenzienoelle.reads · Rating 4 out of 5]

*In MADNESS by Antonia Hylton, puts on her researcher and journalist hats to reveal the 93-year history of Crownsville Hospital, one of the nation's last segregated asylums. WOW. On Threads I posted that this author deserves an award for the amount of research and deep diving she did and dang I hope she gets one! This piece of American history is *shocker* heavy and heartbreaking but so so well put together and conveyed by the author.

[Jill Lesley · Rating 5 out of 5]

Really, really well written and narrated account of the systemic racism that has infected mental health care from its beginnings until now. The personal stories of the individuals who worked at Crownsville and that of the author were very riveting.