Madness by Antonia Hylton review – how racism created a mental health crisis in the US | History books

At the beginning of this heartfelt, deeply researched inquiry into the history of mental illness in America’s Black population, journalist Antonia Hylton describes a regular meeting with a close relative in a park in Massachusetts. The relative – who does not want to be identified in the book – is suffering from a very specific paranoia: they believe that white supremacists are hunting them down.

The relative has, Hylton writes, “covered up all of their windows with black gaffer tape… unplugged all their electronics, convinced they were being watched through every screen”. The worst part of it, she suggests, was that her loved one believed that she, as a journalist – a reporter with NBC – was a passive part of the conspiracy; that she should call an editor and tell the story. “And in a way,” she writes, “my loved one was right.”

In part, this book is her detailed response to that cry for help. In uncovering a century of neglect and incarceration of the disturbed and disfranchised, Hylton dwells on the reasons why her extended family and the wider Black community have suffered disproportionately with depression and paranoia and schizophrenia. A lot, she argues, can be explained by poverty and injustice, the factors most likely to push a person to psychological breaking point, but there is also that other glaring fact: the entirely rational fear that white supremacists are out to destroy them.

The terror of lynching in previous generations, Hylton suggests, has been replaced by a fear of police killings and by the mass imprisonment of young Black men. The rhetoric the far right uses to justify these acts has never changed much. In the years after emancipation, a series of commentators suggested, Black people “immune to insanity” while enslaved were psychologically ill-equipped for liberty. Fast-forward to the present and the nation is set for another election in which those old racist tropes about innate Black self-destruction are fundamental to Donald Trump’s campaign.

The 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 by the forced labour of its first “feeble-minded” patients. At its peak in the 1950s, more than 2,700 people were resident in a place that “existed along the spectrum of asylum and jail and warehouse”. It finally closed its doors in 2004.

Over the course of 10 years of research into Crownsville, Hylton tracked down and interviewed dozens of former patients and employees, and brought a forensic eye to the hospital records that had not been destroyed to conceal decades of evidence of abuse.

Her many case histories show how, for years, people were sent to Crownsville for petty theft, or for destitution or illness, and held in close quarters with the criminally insane.

As the population of Crownsville grew, so the abuses multiplied. In 1943, an employee at the hospital 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 of the patients were naked; “hydrotherapy” was employed by nurses in starched white uniforms, in which patients would be placed in very hot or ice cold baths for long periods; electroconvulsive therapy was used, as in One Flew Over the Cuckoo’s Nest, as much for punishment as treatment.

In the 93 years of its operation, 1,700 patients who died at Crownsville were buried in a field in the facility’s grounds and nearly 600 other bodies sent to universities for dissection. The makeshift burial ground is the site of a recent memorial and an annual “Say my name” ceremony, where the forgotten dead are acknowledged.

As she tells this history, Hylton analyses the psychology of race relations beyond Crownsville’s walls, not least in her own family lore, where she shows how “inequality and racial violence [frequently] had the power to cause an unravelling and to 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 Maynardwho – having started to hear voices – was fatally shot by a police officer in Mobile, Alabama, in 1976, while a studying for his bar exams, after graduating in law.

In among these tragedies are some heroic stories of incremental progress. It took nearly half a century for Crownsville to employ its first minority ethnic member of staff: Vernon Sparks, who in 1948 became the first licensed Black psychologist in the state of Maryland. The beginning of integration, resisted at every turn, saw marginal improvement for the Crownsville patients. The first Black nurse, Gertrude Belt, was the first to wash her patients’ hair; her friend Dorothea McCullers, a seamstress, made inmates’ clothes; and Marie Gough, now in her 80s, was the first to insist that patients could exercise outside.

Those reforms were echoed in asylums across the country. In 1953, the National Mental Health Association invited all hospitals to dismantle and submit any remaining iron chains to be melted down; a symbolic 300lb “mental health bell” was forged from those manacles. Reading of how barbaric experimentation and effective segregation persisted, however, is to recognise the legacy of those regimes in the hopelessly inadequate response to the current epidemic of mental illness, particularly among Black Americans.

Hylton ends her impassioned and rigorous study with an analysis of the killing of Jordan Neely, the Black homeless man killed on the Manhattan subway in May 2023 by former marine Daniel Penny. Neely was characterised as “unhinged” and a “vagrant” in the New York Post, his “crime” being to confront passengers with words that echo down the ages in Hylton’s history: “I don’t have food! I don’t have drink! I’m fed up!” He was choked to death by Penny, an assault filmed by several commuters.

The same scene, Hylton argues, the “othering” of vulnerable Black people as a way of justifying violent and lethal control, has been played out throughout America’s past. “The crises of mental illness, housing insecurity and income inequality bear down on all of us,” she concludes. “We can try to construct cities and communities where these embarrassments remain out of view… but that is only going to get harder.”

At the beginning of this heartfelt, deeply researched inquiry into the history of mental illness in America’s Black population, journalist Antonia Hylton describes a regular meeting with a close relative in a park in Massachusetts. The relative – who does not want to be identified in the book – is suffering from a very specific paranoia: they believe that white supremacists are hunting them down.

The relative has, Hylton writes, “covered up all of their windows with black gaffer tape… unplugged all their electronics, convinced they were being watched through every screen”. The worst part of it, she suggests, was that her loved one believed that she, as a journalist – a reporter with NBC – was a passive part of the conspiracy; that she should call an editor and tell the story. “And in a way,” she writes, “my loved one was right.”

In part, this book is her detailed response to that cry for help. In uncovering a century of neglect and incarceration of the disturbed and disfranchised, Hylton dwells on the reasons why her extended family and the wider Black community have suffered disproportionately with depression and paranoia and schizophrenia. A lot, she argues, can be explained by poverty and injustice, the factors most likely to push a person to psychological breaking point, but there is also that other glaring fact: the entirely rational fear that white supremacists are out to destroy them.

The terror of lynching in previous generations, Hylton suggests, has been replaced by a fear of police killings and by the mass imprisonment of young Black men. The rhetoric the far right uses to justify these acts has never changed much. In the years after emancipation, a series of commentators suggested, Black people “immune to insanity” while enslaved were psychologically ill-equipped for liberty. Fast-forward to the present and the nation is set for another election in which those old racist tropes about innate Black self-destruction are fundamental to Donald Trump’s campaign.

The 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 by the forced labour of its first “feeble-minded” patients. At its peak in the 1950s, more than 2,700 people were resident in a place that “existed along the spectrum of asylum and jail and warehouse”. It finally closed its doors in 2004.

Over the course of 10 years of research into Crownsville, Hylton tracked down and interviewed dozens of former patients and employees, and brought a forensic eye to the hospital records that had not been destroyed to conceal decades of evidence of abuse.

Her many case histories show how, for years, people were sent to Crownsville for petty theft, or for destitution or illness, and held in close quarters with the criminally insane.

As the population of Crownsville grew, so the abuses multiplied. In 1943, an employee at the hospital 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 of the patients were naked; “hydrotherapy” was employed by nurses in starched white uniforms, in which patients would be placed in very hot or ice cold baths for long periods; electroconvulsive therapy was used, as in One Flew Over the Cuckoo’s Nest, as much for punishment as treatment.

In the 93 years of its operation, 1,700 patients who died at Crownsville were buried in a field in the facility’s grounds and nearly 600 other bodies sent to universities for dissection. The makeshift burial ground is the site of a recent memorial and an annual “Say my name” ceremony, where the forgotten dead are acknowledged.

As she tells this history, Hylton analyses the psychology of race relations beyond Crownsville’s walls, not least in her own family lore, where she shows how “inequality and racial violence [frequently] had the power to cause an unravelling and to 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 Maynardwho – having started to hear voices – was fatally shot by a police officer in Mobile, Alabama, in 1976, while a studying for his bar exams, after graduating in law.

In among these tragedies are some heroic stories of incremental progress. It took nearly half a century for Crownsville to employ its first minority ethnic member of staff: Vernon Sparks, who in 1948 became the first licensed Black psychologist in the state of Maryland. The beginning of integration, resisted at every turn, saw marginal improvement for the Crownsville patients. The first Black nurse, Gertrude Belt, was the first to wash her patients’ hair; her friend Dorothea McCullers, a seamstress, made inmates’ clothes; and Marie Gough, now in her 80s, was the first to insist that patients could exercise outside.

Those reforms were echoed in asylums across the country. In 1953, the National Mental Health Association invited all hospitals to dismantle and submit any remaining iron chains to be melted down; a symbolic 300lb “mental health bell” was forged from those manacles. Reading of how barbaric experimentation and effective segregation persisted, however, is to recognise the legacy of those regimes in the hopelessly inadequate response to the current epidemic of mental illness, particularly among Black Americans.

Hylton ends her impassioned and rigorous study with an analysis of the killing of Jordan Neely, the Black homeless man killed on the Manhattan subway in May 2023 by former marine Daniel Penny. Neely was characterised as “unhinged” and a “vagrant” in the New York Post, his “crime” being to confront passengers with words that echo down the ages in Hylton’s history: “I don’t have food! I don’t have drink! I’m fed up!” He was choked to death by Penny, an assault filmed by several commuters.

The same scene, Hylton argues, the “othering” of vulnerable Black people as a way of justifying violent and lethal control, has been played out throughout America’s past. “The crises of mental illness, housing insecurity and income inequality bear down on all of us,” she concludes. “We can try to construct cities and communities where these embarrassments remain out of view… but that is only going to get harder.”