For readers who aren’t familiar with the history you cover, could you talk about psychiatry and race in the Jim Crow South?
Everything about psychiatry, in that period, was infected with the thinking, the structures, and the attitudes of that time. For decades, white doctors and white thinkers in our country were writing, debating, and discussing what they observed to be large numbers and huge spikes of mentally unwell Black people. Many white doctors at the time, including some discussed in the book, thought Black people’s mental suffering was distinct from white people’s, that Black people were unable to handle freedom, so emancipation had in some way been a mistake, and so they needed to be in a separate facility.
What was the role of Black labor at Crownsville?
Crownsville Hospital could not have existed—would not have functioned and survived—without its patients’ labor. It’s the only hospital I found that forced its own patients to build it from the ground up. It is important that people understand that they were not just carrying some sandbags [or] helping out making sandwiches. They were doing backbreaking labor: clearing trees and roads, moving railways, establishing foundations, pouring cement, working alongside electricians. They also forced young boys with physical disabilities to take part in the labor they described in “lunacy reports,” written by officials in Maryland. No patient was exempt from having to do work.
The reality is that, in that period, every asylum had some patient labor—white asylums included. They were supposed to be modeled on European industrial therapy: the idea is you’re learning a trade that is going to make you marketable for a job, when you eventually recover. Those programs were themselves often very abusive to patients of all backgrounds. But there really was no pretense, in the case of Crownsville, that this kind of labor was going to lead you to a job.
It took decades for Crownsville to hire Black medical staff. Did it become harder for white staff to facilitate or hide abuse?
According to the dozens of Black nurses and doctors that I’ve spoken to over the last 10 years, the short answer is yes. They were watching constantly. Often those Black employees found themselves in a position where they were going above and beyond and using their own resources. One woman described bringing in strings so that she could help patients whose pants had repeatedly been falling down. It’s those very small and simple acts of kindness that they felt really no other choice [than] to do so that they could just feel even half-okay functioning at a workplace like this every day.