October 7, 2025 • 56 mins
The United States is in the midst of a monumental mental health crisis, with one in four people predicted to experience mental illness at some point in their lives. Adequate mental health care remains out of reach of so many due to a myriad of factors: unaffordability, stigma, shame, and racism, to name a few, leaving enormous gaps in mental health equity. The roots of these inequities can be traced back decades, to the earliest psychiatric hospitals founded on harmful racist notions of mental illness. In Madness: Race and Insanity in a Jim Crow Asylum, author and award-winning journalist Antonia Hylton explores the story of Crownsville Hospital, a segregated asylum in Anne Arundel County, Maryland, built in 1911 by its first patients: twelve Black men. Over the course of the 20th century, the shifting perspectives of race and mental illness played out in the overcrowded and understaffed Crownsville Hospital, with powerful implications for understanding our current failing to deliver adequate care to all in need. Madness is a powerful and necessary book that sheds much-needed light on the intersections between race, racism, and mental illness.
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Speaker 1 (00:44):
Hi, I'm Aaron Welsh and this is this Podcast Will
Kill You. Welcome to another episode of the tp w
k Y book Club, where I bring on authors of
popular science and medicine books to ask them all about
their latest work. This is truly one of my favorite
things to do because I get to learn about so
(01:04):
many fascinating topics like just this season alone, we've covered measles,
the history of the pelvic exam, phase therapy, the aerobiome,
and we've got more on deck for the rest of
the season. If you want to read ahead or see
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(01:25):
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(01:46):
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(02:06):
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the exactly right Media YouTube channel so you never miss
a new episode. Drop. It is twenty twenty five. We
(02:27):
are a quarter of the way into the twenty first century,
and we are still failing in many ways to deliver
mental health care to those in need. Stigma, shame, dismissal, sexism,
and racism are all embedded in the way we view
and treat mental health issues, affecting who is deemed worthy
(02:49):
of receiving care and what type of care they receive.
And as the police have increasingly and inappropriately been called
on to respond to mental health health crises, Black Americans
and other people of color experiencing a crisis are disproportionately
more likely to be harmed or killed by police, imprisoned,
(03:11):
rather than given the help and mental health resources that
white Americans are more likely to receive. The roots of
these inequalities, which are ingrained in our current medical andcarceral systems,
stretch back generations. To make lasting and effective changes in
the way we approach mental health in this country, we
(03:31):
need to turn to the past to understand its role
in shaping are present in madness, race, and insanity. In
a Jim Crow Asylum, author Antonia Hilton explores the story
of Crownsville Hospital, a segregated asylum in ann Arundel County, Maryland,
built in nineteen eleven by its first patients, twelve black men.
(03:52):
Over the decades of its operation, during which it grew
into a compound housing thousands of patients, Crownsville became, in anyways,
a microcosm of the dynamics between race, mental illness, medicine,
and the civil rights movement playing out across the United States.
Expertly blending oral histories with archival materials, Hilton, who is
(04:14):
an Emmy Award winning anchor and correspondent for MSNBC and
NBC and New York Times bestselling author, presents a nuanced
and moving examination of an overcrowded, understaffed Jim Crow institution
that shaped the lives of those who lived or worked there.
Hilton also reveals how the shift in focus from asylums
(04:36):
to prisons in jails was reflected in Crownsville's operation. Madness
is an urgent, necessary, and powerful work that sheds much
needed light on the intersections between race, racism, and mental illness.
I'm really excited to share this conversation with you all,
so let's take a quick break and get started. Antonia,
(05:21):
thank you so much for joining me today.
Speaker 2 (05:23):
Thank you for having me. I'm so excited to do this.
Speaker 1 (05:26):
In your book Madness, you tell the truly haunting and
heartbreaking story of Crownsville Hospital, which is one of the
last segregated asylums in the US. How did you first
come across this story?
Speaker 2 (05:39):
Well, I first came across the story of Crownsville my
freshman year of college, and it was there's sort of
two origin stories I always tell people about how I
came to this place. The simple one is it's my
freshman year. I'm trying to figure out who I want
to be and what I want to study, and I
stumble into a class called Madness in Medicine that I
(06:01):
didn't even know was something that could exist, A course
all about the history of mental health care treatment in
the Europe in the United States, and I learn all
about the development of the asylum, the development of medications
to treat mental health challenges, and as I grow deeper
and deeper into the course, there's this thing gnawing at me,
(06:23):
which is that I'm learning about the history of mental
health care mostly from the perspective of European or white
American people. And I knew something was wrong with that,
not just from you know, basic instinct, but because I
have family members who were very deeply impacted by the
system themselves in the US history of mental health challenges
(06:43):
in my family, and so I knew that there were
black people, black patients, black providers who worked in these spaces,
who contributed and tried, and I just went looking for
a way to learn more about that at first. And
so I go looking to find out about the asylums
the institute US that worked with black patients, And what
I found was a system of segregated asylums built in
(07:06):
the decades after slavery came to an end in the US,
and many of them closed down, were the subject of scandal, burned, files, destroyed.
There's one asylum that a great grandfather of mine spent
some time in that has been turned into a kind
of Halloween theme park sort of experience. Yeah, I made
(07:28):
the same face when I first found that out. Wow.
And so in many cases I just kept hitting these
like dead ends. Okay, not much here, there's just a
paragraph about it here. And then I found Crownsville. And
Crownsville is unique and not unique in a number of ways.
Unique in that it is one of the only ones
that were part of this network, a segregated asylum with
(07:52):
existing records, living people and patients who had been at
this place, and a campus that is still standing even
to this day. In fact, it's in really the heart
of Maryland, in an Arundel County, and the county and
the state is engaged in a massive sort of rehabilitation
and reimagining project as we speak. And so there was
(08:13):
this opportunity to feel the place, to see it, to
walk through it, to talk and sit with people who
knew it intimately, and then to also petition the state
of Maryland for access to its records. And that was
unlike really any other opportunity. I'd say. There's one similar
place in Virginia called Central state that there's similar opportunity there,
(08:36):
but this was so rare, and so I just dove
in and I became obsessed. The longer story, and perhaps
the more true story, is that when I was eleven
years old, I had a conversation with my father about,
you know, cousins, and my cousins had just been visiting
(08:56):
our house and I asked my dad, you know, I
guess something must have clicked in my I had, Hey,
why haven't I met any of your cousins? Do I
know any of your cousins? You must have some And
he said, well, you know, there's an uncle who you
think is an uncle, but he's technically a cousin, but
you call him uncle. And that's something that I know
many people can relate to. And then he said, and
then you know, some of my cousins have lost touch
(09:19):
with them. One was incarcerated, and then one was killed
by a police officer in the middle of a mental
health episode, and we don't talk about him very much.
And that was my first time ever learning that my
dad had had a cousin named Maynard growing up, who
he had loved and admired. He kind of wanted to
be Maynard and in many ways, he actually did follow
in that cousin's footsteps. My dad is a lawyer. Maynard
(09:41):
was a lawyer when my dad was little, and he
developed schizophrenia and was killed by a police officer during
an interaction in public on the steps of a federal
building in Mobile, Alabama in the seventies. And I was
too young at the time to talk to my father
about that. I didn't really know how to ask good questions.
But then I became older and I asked a little
(10:03):
bit more. I became a journalist, I became a pest,
and I started to understand who Maynard was and just
how much his death had transformed my family. And I
think that in a way, for me, this story really
goes back to my childhood, to the discovery that there
had been all these stories in my family, these experiences
people who had tried and failed to seek treatment in
(10:25):
the system that set me on this path. Made me
so curious in my bones to try to understand this
that it set me up to be in a place
where then when I am this young student, it all
kind of clicked together. And so that's why I always
tell both of those stories, because there's this sort of
surface level story. But then there's like the what said
(10:47):
times has felt for me like this, like familial mission
I have been on almost like I don't know so
much that I had a choice. It just sort of
feels like all these things fell into place and they
were right, and they were the thing I had to do,
and that is what brought me to Crownsville and to
this unbelievable story.
Speaker 1 (11:05):
I mean, there are so many elements to the story
that you tell and in your book that it's not
just the effects of Crownsville Echo today, it's that they,
you know, have dictated, They have made the world that
we have today in terms of mental health care. And
I think it really helps sort of contextualize how today
we are still failing in many respects to provide adequate
(11:28):
mental health care. And I want to go through the
full story, but I want to touch on something that
you mentioned early on, which is the difficulty in obtaining
source materials. And I'd love to hear more about your
research method and your process for incorporating these different types
of source materials together, like which elements do you pull from?
(11:48):
What was that entire experience like for you.
Speaker 2 (11:51):
Oh boy, it was a lot it's short answers because
I was so young. So keep in mind, you know,
I begin this process as a literal teenager. I'm like
nineteen years eighteen, nineteen years old. There's a lot I
did not know about the world and how all of
this worked. And so my first real task at working
(12:14):
with I was really lucky to have Evelyn Hammonds at
Harvard as my PSIS advisor. I had her help and
some other people in the Harvard History of Science Department
really guide me through this. I don't know that I
would have gotten it done without them, but the process
of going through Institutional Review Board Human Subjects Research Approval
and getting the State of Maryland to give me permission
(12:36):
to come to the state archives and access records that
they typically refuse to share. In fact, it's a point
of contention for many people in the black community in
Maryland who have routinely asked for access to these records
and been denied it. And so I think I didn't
appreciate how hard it was going to be. I thought, Okay,
there's some rules on this website. I'm going to follow
all the rules. I'm going to take the tests they
(12:58):
tell me to take, and then they're going to let
me go. But you know, there were some politics that
got into the way and some people that dragged their feet,
and so it was helpful to have the backing of
that institution to come in and sort of apply some
pressure to make sure that I could get in there
and get my work done. And so that was to me.
(13:19):
I thought, like, Holy Grail, I'm going to go into
the state archives and everything will be there. I will
know everything about this place as soon as I can
get my hands on these primary source documents. And then
I finally do, and it is incredible. Let me not
downplay what's in there. I mean, there were monthly reports.
(13:41):
There were writings and letters that superintendents who ran the
institution had written to themselves or privately to other state leaders.
There were certain patient records, but whole lot of patient
records missing. And I very quickly realized this wasn't the
hoil that I thought it was going to be. That
(14:02):
most of what happens when an institution of that nature
closes down and people preserve what remains is the sort
of clinical perspective and the leadership perspective is preserved, but
the patient story that is not respected that's not maintained,
that's not preserved as as well. And in fact, as
(14:23):
I later learned in my journey, I didn't know this
at the time. Employees of the institution alleged that there
was a systematic effort to destroy a lot of the
patient stories because there was a fear from the state
in their view that perhaps lawsuits could come from that,
that it would be more trouble than it was worth.
And so I realized, even as a very young person
sitting there in the Maryland State Archives, oh wow, I'm
(14:47):
going to need to launch like a big oral history project.
I need to go talk to people. I need to
meet people. I'm going to need to make up for
the voices that are missing in this place and find
them elsewhere. And that it took a long time because
humans are human and you have to build trusts with people.
You have to call them, write them snail mail. I
(15:09):
mean a lot of the former employees they were at
the time and they still are quite elderly, and so
I couldn't text them and DM them on Instagram or something.
I had to really do some like shoe leather reporting work.
And in some cases there were some people I was
able to meet very quickly Pauler's for example, Paulers worked
(15:32):
at the institution for forty years, social worker who dedicated
his life to children at Crownsville. He was very quickly
willing to speak, but so many people had been affected.
I'd been traumatized in some cases by what they experienced
at Crownsville, and so it took a while to build
their trust. There are people in this book who took three, five,
seven years to decide to talk to me, and I
(15:54):
had to be really patient with that and respect that
there were people who didn't want to talk on the phone,
but they were willing to talk if I came and
knocked on the door and I sat on their porch.
And so the level of investment and patience that comes
with that, I really I grew into it in a way.
I started out as this young person who was just
calling people up, and I should be grateful that anyone
(16:15):
answered to a nineteen year old's phone calls. First of all,
let me say that. But then I became an adult
and a professional journalist, and I got the resources to
be able to do the sort of real like sitting
in the community and being present work, and that is
what transformed everything. I think those stories, those memories, they
(16:38):
are the richest part of this book. You know, the records,
they are fascinating, They are valuable. I worked with so
many of them in the story. But it's so helpful
to have the sort of sites, smells, sounds, and stories
from people who were so personally impacted by all this,
whether they were the patients or they were the providers,
and in many cases they really fill in critical gaps
(17:01):
or you know, the records in some cases actually confirmed
some of the stories that were found out in the community.
And with an institution like Crownsville, it's huge for anyone
listening who lives in the Maryland area, like it is
worth driving by and seeing this place because you'll get
a sense of just the immensity the number of people
(17:21):
who were touched by this place over the almost one
hundred years that it was in operation. And what comes
with that is there's amount of community rumor and storytelling
and all of that that you have to wade through.
And having the community and having the trust in the community,
and then having the records and bringing those complimentary pieces together,
(17:42):
it allowed me to find a way to tell a
story that had either been both sort of simultaneously pushed
under the rug but also sort of festered as a
mythological thing for a really long time. And it was
the ability to do both of those things that helped
me find the truth, the core of what happened there.
(18:04):
And I see the record, the sort of painstaking archival
and research process as being just as important as the
oral history endeavor to.
Speaker 1 (18:15):
Let's take a quick break and when we get back,
there's still so much to discuss. Welcome back everyone. I've
(18:37):
been chatting with Antonia Hilton about her book Madness, Race
and Insanity in a Jim Crow Asylum. Let's get back
into things. What emerges is this really rich, sweeping perspective
like the storytelling of asylums and the representation of asylums
that happens often in popular media like movies, is very
one sided, one dimensional, or just one perspective. And that's
(19:00):
one of the things I really appreciated about your book.
And I would love to turn to the beginning. Why
was this institution and other institutions like it? Why was
it built and how did its surrounding context both the
time period in which it was established and the location
that it was established in how did that shape what
(19:20):
it would become.
Speaker 2 (19:22):
The context is everything Crownsville is created. It is founded
in nineteen eleven, and this is a fascinating time in
the United States. Were a couple decades after the end
of slavery, and there have been these immense contradictions in
American society. I mean, black people have in some cases,
they've become lawmakers, they've started incredibly successful towns and communities
(19:45):
in places like Tulsa, Oklahoma, and they're gaining ground. But
then there is a massive backlash and backsliding that starts
to steal some of that ground back. And there's an
effort and a lot of that effort actually begin in Maryland.
A lot of people don't know this. You know, Maryland
passed one of the first segregation ordinances in the entire country,
(20:07):
if not I think the very first segregation ordinance in fact.
So there is this effort to try to put black
people back in their place. But there also is for
the black people who you know, haven't found the Tulsas,
who haven't maybe found their footing yet. There's this sort
of incessant writing going on in white intellectual circles. So doctors, lawyers,
(20:29):
politicians who are really obsessed with what they describe as
this problem of Negro insanity, Negro alcoholism, Negro waywardness. They
are observing that there are all these black people who
seem to be traumatized and struggling and unable to adjust
to life post enslavement. And you know, looking back on
(20:50):
it for us now, that perhaps doesn't seem so surprising
that people found that experience, you know, hundreds of years
of enslavement to be traumatizing for their families. But at
that time, you would think think they thought that everyone
would get over it in a year or two. That
just simply hadn't been the case. So they're writing in
these letters to each other or they're publishing in medical
journals these observations that were incredibly dehumanizing. On the other hand,
(21:15):
then they're expressing pity and saying, well, we need to
do something about it. We got to do something about it.
But what they decide to do is create a place
to treat them. But they must be separate from white
people because these antebellum attitudes that black people are inherently different,
they seeped into everything. I mean, I think people understand, okay,
separate Water Fountain, separate schools, but they forget I mean,
(21:38):
it went into healthcare treatment. It meant into basic conceptions
of how the mind in different people would work. And
so they make the decision that there need to be
these separate places for treatment, and Maryland takes it one
step farther. They decide that they're going to create this asylum,
but they don't really want to pay for it, and
(21:59):
they're going to ask, not ask, They're going to force
these patients to build it for themselves. So it begins
with twelve black men who are brought from almshouses, poorhouses
around the state, brought into a forest and if you
know the Maryland area, it's sort of the modern Bacon
Ridge natural area, and there's nothing there, nothing, not a
(22:19):
place to sleep, no cabins, and they are told they
have to get to work, build yourself an asylum, move railways,
move tracks, construct roads, clear ground. I mean really monumental labor.
They're working side by side with contractors hired by the state,
but the patients did an immense amount of the backbreaking,
(22:42):
really physical labor. And weeks go by as they're doing this,
and they bring new patients in and new men in
and actually also boys. There are state records describing you know,
putting boys who are about ten to twelve years old
who are disabled, physically disabled to work and being proud
(23:05):
that they were able to get them to carry you know,
pails of water or other items around and get them
to contribute to this effort. And the sort of tone
is always that they should be grateful that they're given
this work, that it must make them feel better, you know,
and that once this project is done, they'll march into
the rooms that they just built and they'll become its
(23:26):
first patients. So that is how Crownsville begins, and that
is the racial and political context at the time.
Speaker 1 (23:35):
How was mental health like was mental health a concept?
How was mental health different than mental illness? And what
were the prevailing ideas around treatments or therapies and you know,
what options were available to for instance, a black person
in nineteen eleven in Maryland that if they were experiencing
(23:57):
a crisis, where could they go? Could they go anywhere?
Speaker 2 (24:01):
I really appreciate this question. Actually, you might be the
first interviewer to ask me that in that way, because
I think it gives me the chance to make an
important point which is that I think often, you know,
in twenty twenty five, we look back at a time
like nineteen eleven and we think, well, people just didn't
know anything, like it was all pretty horrible. And look,
(24:23):
a lot of the mental health care treatment, the majority
of what was available was terrible for everybody. I mean,
if you actually talk to psychiatrists and biochemists and to
therapists and people who work in the space today, they'll
still tell you that we may be in the dark
ages of understanding how the mind works at this current moment.
So certainly nobody's going to argue that what was available
(24:43):
in nineteen eleven was incredible. And you know that there
were quick fixes all around, No, not for anyone, But
there were ways in which leaders made very deliberate decisions
to give people of color the absolute worst of what
was available. You know. For example, they knew that tuberculosis
(25:04):
was an incredibly dangerous disease that impacted people's physical and
mental health, but they were careful to create separate, quarantined
wards for that. At all white institutions, they refused to
do that. However, at Crownsville, they knew that this disease
would kill or physically and permanently disable all kinds of
(25:25):
people in these in Crownsville, but they allowed it to
fester anyway. That was a price, a sort of just
a reality they were willing to accept, despite writing and
openly knowing that to do the opposite was the right
thing for another set of patients. And the other interesting
thing I should say too, is a lot of these
(25:45):
therapies are complicated to talk about because they may sound
horrible at first, but there are clinical arguments that have
been made for them. For example, electro shock. A lot
of people horrified by the concept of electroshock, but there
are still people doing electro shock to this day, and
there are patients that will tell you that they love it,
and so you know, while at Crownsville there are a
(26:05):
lot of stories of abuse of patients through electroshock, there
are stories of clinicians believing that it was a valuable
tool that helped them gain insight and make treatment breakthroughs
with patients at places like Crownsville too. Hydro Therapy is
another example. Hydro Therapy is a tool that for some
patients could be incredibly relaxing. It was the experience of
(26:28):
being submerged up in water in a tub sort of
up to right under your chin, and you would be
either an incredibly hot or incredibly cold water for a
period of time. That period of time could be a
couple hours, it could be up to three days. At Crownsville, now,
spending a couple hours in a very warm tub for
some patients was apparently in some cases very relaxing. Spending
(26:51):
three days in a very hot or a cold tub,
some would call that torture. And so every single one
of the sort of modalities available, you can pause, or
you can do the reading and see a completely different
way of looking at its application and the potential for harm.
(27:13):
And so there's sort of the baseline story of what
was available and how difficult and how dark the treatment
of the mind was at that time. But then there's
also just sort of the need to understand that as
you look at the different kinds of facilities that always
what you saw was the same pattern repeated, not just
in Maryland, but certainly that's the place that I studied,
(27:35):
that the black patients were going to get the worst
of what was out there, and we're going to have
the fewest sort of clinicians and aids available to support them.
I write at one point about records that I found
that showed that as the state rehabilitated a bunch of
the different asylums in the state, that they sort of
(27:56):
consciously made the decision to build less therapy spas at Crownsville.
So sort of this idea that there was going to
be room for patients to even just have space to talk,
to reflect, to work with and be in conversation with
a provider. You see the way in which sort of
attitudes are reflected in expenditures and structural decision making. I
know people don't love talking about structural racism anymore, but
(28:21):
you see a lot of it, very obviously in the
story of Crownsville. And so it's complicated because there are
these moments in this story where people are able to
do genuinely great work with patients at Crownsville, especially after
integration and more members of the community are able to
get the chance to take care of people who look
like and who know them. But there are also there's
(28:44):
also the element of horror. There's also an absolute reality
of abuse, and all of those things existed and coexisted
and could happen on any given day at the very
same time.
Speaker 1 (28:57):
Let's take a quick break here. We'll be back before
you know it. Welcome back everyone, I'm here chatting with
(29:17):
the wonderful Antonia Hilton about her book Madness. Let's get
into some more questions. The way that this plays out
is such a nuanced way, where you have these prevailing
notions about how the mind works, how mental illness works,
and then also you have this racism that's baked into
so much of the way that that is informing that
(29:37):
a lot of the physicians, for instance, who are providing
the treatment and so on, and then and of course
funding and all of that. And initially it seems like
for at least a period of time, Crownsville's predominant role
was not too necessarily, or maybe it was in combination
to provide care for those with mental illness, but also
(30:00):
to exploit those individuals for their free labor. How did
this factor into how long someone was held at Crownsville
or was lived at Crownsville, And when did awareness of
this sort of mistreatment or these instances of mistreatment seep
into the surrounding communities.
Speaker 2 (30:21):
The question of exploitation is a really important one because
it is there from the very beginning, I mean, the
story of its creation. It's almost like when I tell
people the story, it almost sounds like biblical or mythological
to them that these twelve men are in the woods
and they hear the news that they have to build
themselves a hospital. So the exploitation begins before the hospital
(30:44):
has any sort of physicality to it, and then when
the hospital opens and its operations start, that is really
just the beginning of very long workdays for the majority
of the patients there. Unless you were essentially completely physically disabled,
you were expected to offset the cost of your own
care for many decades, the first essentially three four decades
(31:06):
at Crownsville. There is this massive pressure on patient labor
there in areas that were unusual to so in the
twentieth century, there was a very common concept actually even
before that, of this idea that having vocational training for patients,
(31:27):
for people struggling with their mental health would be good
for them. It would mean that when they get out
they get great jobs or they have an apprenticeship, they
have opportunity, or at least they can be helpful to
their families if they're staying at home, and so Lots
of asylums had jobs, programs or chores that patients needed
to do, and Crownsville was no different in that respect.
But the hospital had an entirely other layer of labor expectations.
(31:52):
Unlike anything seen in Maryland or really most of the
institutions I've ever studied, Crownsville expected patient to run a
highly modern and productive farm with modern irrigation practices. They
farmed tobacco, they worked with cattle. Women were expected to
(32:14):
basically constantly be working with food and produce, or in
the kitchen or in the laundry. And it was to
such a powerful extent that this is remarked upon consistently
in state records, really as a point of pride that
we're able to keep the cost down at this place
because we made the patients run the place themselves. They
(32:35):
were proud of how much they were able to get
them to do it. And then even they take it
again another step too far. They are extracting from creative patients.
So people who create rugs or did basket weaving, they
start to sell their goods, and none of that money
comes back to the patient themselves. It's used again to
offset the costs of their care. They send items that
(32:57):
patients at Crowns will made out to competition, and the
superintendents would display and brag about them as if they
were almost theirs. And so there is this sort of
constant air of exploitation there, and it doesn't start to
shift until really, I mean, I guess it depends on
(33:18):
your idea of what a shift looks like, if it's
the rumor mill, if it's awareness in the community. The
black community became aware of a lot of this very
early on. There were a number of patient murders. I
write about one, the father of civil rights icon Polly Murray,
her father William Murray, murdered by an allegedly pretty openly
(33:38):
racist guard at the hospital. Stories like that they spread
among black community members of Annapolis and Baltimore. They didn't
necessarily get the attention they perhaps deserved in the papers
like the Washington Post or Baltimore's Sun, but they certainly
were known about. But real action begins, say in the forties,
(33:58):
when there are these sort of budding civil rights movements.
There are lawyers and growing budding associations like the NAACP
that are starting to sort of demand access, demand meetings
with state leaders and the superintendents of Crownsville and get
in there and actually start taking testimony from patients. And then,
(34:21):
to give a little credit to my field, there are
reporters who start asking questions. At all the major papers,
there is a series of expose as, but there's also
some incredible work done. I have to shout out the
Afro American newspapers because those reporters consistently published diary entries
of patients on the first pages, unlike anything any of
the other papers were doing. And they allowed patients to
(34:43):
tell their own stories and their own voices, and weren't
always taking the word of say the police or the
superintendent above theirs. And so there's a lot of richness
there in the record that you can find by looking
at some of the alternative or minority media at that time.
And so that's when the sort of consciousness that guests
(35:04):
starts to shift is in that period in the forties,
and in a way it's no surprise America is engaged
in a horrendous world war. The hospital is starting to
receive and welcome in Jewish men and women who are
fleeing the Nazis and who are coming to restart their
lives in the United States, they come to work at
places like Crownswell, and they too are outraged by what
(35:26):
they see there because they've seen this, They just escaped
a system of extinction, and now they come to this
place and they see the patient labor and the exploitation
for what it is. And so you have all these
factors that are coming together in that period that are
leading to these new coalitions that are getting ready to
transform this place.
Speaker 1 (35:46):
This broader shift not just within the recognition of Crownsville,
but this shift in the mid twentieth century that you
describe in the way that the general public and medicine
begins to see mental health and psychiatric hospitals these views.
Of course, the shifts and these views are not consistent
across the race of the patients, right, And you point
(36:08):
out the differences in this framing where white patients are
said to well, well, we need to rehabilitate, but black
patients it said, oh, well we need to manage. How
did this play out at Crownsville.
Speaker 2 (36:22):
This is again actually where some of the most valuable
records were the work of reporters, because they would talk
to community members and kind of publish their unvarnished thoughts
about what should be done about places like Crownsville or
similar peer white institutions like spring Grove or Springfield in
the state. What I found was that just as you mentioned,
(36:43):
there's this movement after there are scandals in the asylums
and reporters are starting to get the story out there,
lawyers are starting to make demands. There's this growing movement
in the United States that begins in the forties and
really extends for decades onward to rein best in community care,
to bring people home, to have more empathy for the patient,
(37:04):
to be willing to hear their side of the story,
and to share their narratives in the paper, in media
and movies. Really there was a sort of explosion. But
then what I found is that when it came to
black patients, the communal response was very different. There was
a fear about release, there was a fear about what
(37:25):
it would mean to welcome them back into the community,
and that often reporters in my field then they made
a lot of mistakes. They over exaggerated and sort of
misreported the extent of for example, escapes or riots at
a place like Crownsville, as compared to what was happening
at pure white institutions. And I found records of even
(37:46):
superintendents who know none of the patients, would have described
as their ally. They would acknowledge that the crowns will
the amount of violence or escapes at that site were
being sort of unfairly highlight or featured in the papers,
even when pretty much equivalent events were happening elsewhere. I
(38:06):
spent some time going through just some of the language
the adjectives used by reporters at the time, too, that
when they would talk about a white patient who escaped,
they would often describe sort of the person's melancholy, how
fearful they were. I remember, I don't think I included
in the book, but I remember reading one paper describing
a white male patient escaping one institution, and the paper
(38:29):
was kind of making jokes about the red fluffy slippers
that he escaped into the woods wearing. Whereas and I
do include these in the book. I write about some
of the young black male patients who are written about
as though they are any minute now going to come
into the suburbs surrounding the institution and rob rape and
(38:49):
terrify people. And there are descriptions of people saying, you know,
after they've heard about an escape, that guns are going
out onto porches tonight, and people are sort of fantasizing
about this fear of their wives being left home alone.
And there's this sort of juxtaposition always between sort of
white domestic life and the threat of the people inside
(39:11):
Crownsville again, even though at the same time, the same
number of patient escapes are pretty routinely happening at pure
white places as well, And so there is a perception
that follows then, of course, and what follows from the conversation,
the cultural conversation, the perception is political action. People start
(39:32):
advocating to build a wall around Crownsville anyone, I don't know.
Maybe they advocate for morelock and key policies. They want
to bar patients from being able to visit communities. There's
this massive carceral push to keep them behind bars at
all costs, even as clinicians keep saying, we know from
(39:55):
the evidence from the work we're doing with these patients
that what they need is actually more community support. We
need to be able to hire more people they need therapists.
There are patients every week getting zero time with therapists
or psychiatrists at the hospital. Basically they're just like sleeping
there and working there all day long. They're not actually
getting the treatment and rehabilitation that this place was supposed
(40:17):
to provide. And so there's the people who sort of
know the people in the place begging for one thing,
but the community, because of what they've grown to fear
and believe, pushing for the exact opposite. And in many cases,
the community and the sort of people filled with this
false perception they went out and one of the tragedies
(40:41):
of Crownswel, and I often use Crownswel to help people
understand concepts around structural racism and sort of the ways
in which our past informs always our present moment is
that because of what happened in Crownzell's founding, that the
state always wanted to spend less money on it. They
never invested in its building completely, they never invested in employees,
(41:05):
they never invested in making sure there were good doctors
and clinicians there. They didn't want to build the proper
amount of therapy space. They barely had food and soap
available during World War Two, when patients there were literally
suffering and dying. Even when this sort of civil rights
movement gets some wins, there's integration and there are changes coming,
(41:26):
and there's sort of new standards and rules by which
all these places have to operate. Crownsville is operating at
a deficit. They're never given back the money they were
never provided, and so all these new sort of institutional
and legal and healthcare care related laws and regulations come
into place. There are these high expectations of the place
(41:47):
after integration, like Okay, let's see what you all can do.
But they don't have money. They're operating with an institution
never built with what it needed to properly survive, and
so they end up kind of stuck in this heads
you lose tails, you lose situation, and it's heartbreaking for
(42:08):
the institution and it haunts it from the period we're
talking about all the way until it's closure in two
thousand and four.
Speaker 1 (42:14):
This period of time too is as I find this
so interesting, this shift in the framing of how we're
viewing mental illness and then also sort of the weaponization
of diagnosis that still happens today, where you get these
shifts in or these changes in the way that certain
conditions are labeled or you know, for instance, schizophrenia is
(42:37):
one that you discuss in your book. And of course
there's another book, the Protest Psychosis, that goes into this
as well, where it starts out as this sort of
this diagnosis of mothers, homemakers who are burnt out, and
then it transforms into this opportunity to pathologize young black
men in particular, especially during this period of time. What
(43:00):
was happening at Crownsville as far as that goes, or like,
was that bleeding into there as well?
Speaker 2 (43:06):
Oh? Absolutely. And I have to give a shout out
to Jonathan Metzl, the author of The Protest Psychosis. He
was so helpful to me when I was an undergraduate
trying to learn how to do all of this stuff,
and we have been so supportive of each other's work since,
and so I cite him a lot in the book,
and that's no mistake, Like I couldn't have done a
(43:27):
lot of this work without his help and his feedback
at many points. Crowns Will absolutely reflects that story. You
see it in the records, but you also see it
in really and what I found most interesting was the
recollections and the testimony of the people who were there.
There's this really just fascinating transition coming out of really
(43:48):
the civil rights movement where you start to see all
of these clinical changes that they're starting to change that
labeling as you just spelled out. So schizophrenia is becoming
more of something that is about paranoia and aggression and
all of these assumptions around black men and masculinity, and
it's shifting from being sort of pictured or illustrated as
(44:10):
a disease mostly of I guess, being withdrawn into yourself,
and so it's sort of seen as this explosive thing.
I even show in the book some examples of psychiatric
ads and ways in which the conversation and the depiction
of who suffers from schizophrenia shifts at the same moment
that these movements these protests are happening. There's one psychiatric
(44:32):
ad that I'll never forget that depicts a black man
like hanging from fiery bars and looks like he's in
the middle of a protest that's burning some kind of
city to the ground. And he is the image that
is accompanying a medication to treat schizophrenia and other diseases.
And so you see that and if you're a person
of that time. That is absolutely when you're talking about
(44:54):
a time in which there were massive protests. I mean
Martin Luther King murdered and that impacted Crownsville. People there
process that in real time, staff members, patient, family members,
they attended the march on Washington. I mean, all of
this is interrelated. It's all part of the cultural context
to the story. So you see it from the clinical perspective,
(45:16):
but also I enjoyed hearing the memories of people who
could describe it for you less as this sort of
academic pattern and more is just the real thing that
they saw every day at work. I spent a lot
of time with this psychiatrist who actually still lives and
works in ann Arundel County, Maryland to this day, named
doctor Brian Simms. He was one of the first black psychiatrists.
(45:39):
He really helped pioneer trauma informed care at Crownsville. And
this is in the latter part of the book, and
he writes about seeing police bringing a boy who's about
six years old to the hospital in a karate uniform.
He's misbehaved in karate class and he's brought there. He
and many other described to me seeing patients you chained
(46:02):
to polls while they waited to find out where they
were going to be sent. Within the institution, the sort
of constant flow of court committed patients who judges sort
of decided were one week maybe they would go to
the jail, the next week they were fit for Crownsville,
And how doctors like him had to get on the
phone and battle it out with judges and try to
(46:23):
explain to them what was and wasn't appropriate, what was
a clinical necessity and what wasn't, and that it was
an exhausting, sort of unpaid part of their labor, and
that they saw a lot of it as incredibly racialized,
that kind of the second they saw a black person
with pain and confusion and who had perherhaps committed a
low level crime, that to them there was this sort
(46:46):
of fear of derangement and a desire to have them
stuck at a place like Crownsville. And that was really
heartbreaking for the people who worked there. And the way
that they tell those stories, they capture it so much
better I think than a journalist or an acade even can,
And so I tried my best to retell those stories
in their voices, but you absolutely see it play out.
(47:06):
And the doubly heartbreaking part is that those same doctors
then respond by trying to create sort of a community
based solution. So, Okay, we're going to create a program
where we ourselves drive to visit our patients out in
the community. We're going to make sure they stay on
their medications. We're going to make sure they don't go
back to court that they because a lot of patients
they end up on what's essentially sort of the mental
(47:28):
health equivalent of like probation, where any missed appointment could
send you back to the hospital. And so these doctors
are committed to trying to get people out of that cycle,
because I mean, who among us hasn't missed a doctor's
appointment to be told for five years that you can
never miss an appointment and put people at a meense risk.
So they sort of put a lot aside in their
(47:49):
day to day jobs and drove out there into Baltimore,
into all these other neighborhoods to make sure their patients
made it anyway, and after seeing immense success, seeing the
recidivism drop precipitously, they're told by the state that this
isn't a good use of their time, and that the
program needs to disband. And so you saw that lack
(48:10):
of compassion and the way in which the attitudes you
have about a certain community create a kind of permission
structure and a sort of attitude from the top down
where anything that would actually solve the problem you claim
to be so alarmed about isn't worth spending money on.
But the one thing consistently we're willing to do is
behind bars, behind bars, behind bars. And it is absolutely
(48:35):
a part of the Crownsville story, and it's something that's
stuck with so many of the people who worked there
for decades onward.
Speaker 1 (48:41):
Crownsville acted as almost like a place of dual purpose,
where you have it as a psychiatric facility on one hand,
but then this unofficial detention site on the other. And
this also, as you describe in your books or plays
out on the national scale, where you have this decline
in psychiatric hospitals, just as you see this expansion of
the prison system in the US. Can you tell me
(49:03):
a little bit more about that.
Speaker 2 (49:05):
Yeah, what I'm arguing in that section of the story
is really that it's not such a simplistic story where
the asylum disappears and everyone goes to prisons. But that
you have to see these institutions as being in conversation
with each other and as sharing DNA, being part of
(49:26):
the same genealogical timeline, and that it isn't a coincidence
that at the moment that we are starting to disband
this massive institution that at one point was the dominant
institution in the United States and the mid twentieth century,
the asylum was much more prevalent and powerful. There were
more people there than there were in our prison system,
(49:49):
and so you see the decline of that place and
this explosion in the other And Crownswell is a fascinating
window into that because again it's you can see how
it worked in real time and in day to day
human interactions. I write at one point about a report
that breaks down what was essentially going on inside of
(50:14):
peer white institutions and Crownsville, which at that point had
been desegregated but was still majority black, as they were
trying to transition patients out of the institution back to
the community. Sort of a simple government study trying to
look at what was available to those people in those
different groups as that process unfolded. What they found was
(50:35):
that at a peer white institution, there were vocational trainers available,
There were counselors and teachers and family members present at
these hearings, essentially where someone would get approved to go
home or not go home, and they would be connected
with opportunities and resources afterward. The report found that at
(50:56):
Crownsville there were juvenile probation officers present, there were often
no educators, nobody hiring out in the community, no vocational support,
and so there was much more common that there would
be someone who had a tie to the prison and
jail industrial system, and a lot less likely that there
would be somebody who was about to connect that person
(51:19):
with a bright future, a job opportunity, and an appointment
to make sure that they stayed on their care schedule.
And so even then, as this is happening in real time,
there is a knowledge that it's not happening the same
for everyone. This whole idea that we had become so
empathetic and interested in supporting patients and bringing them home
(51:43):
was not applied evenly to all populations, and so it's
no surprise then that our prisons and jails are full
of black people, many of whom clinicians CEOs will tell
you they think actually need mental health care, treatment and
(52:04):
support and are likely regressing in a car soral setting
like that. And it's the kind of maddening moment we're
living in right now. I mean, I think about it
a lot, in particular as we look at what's unfolding
in Washington, d C. And we see this big push
to just get the homeless out of there, just push
them out, like the President basically saying that he doesn't
(52:27):
care where they end up and where they go, but
they can't be here. And the idea that well, okay,
you either find yourself a shelter or something you're gonna do,
or you're gonna end up in jail. That attitude, it
came from somewhere, and we saw all these shifts, and
in many ways I describe basically the black patient as
(52:48):
sort of the lynchpin that held these negotiations together, through
which you can see how so many of these decisions
and disparate actions were taken. And that's really one of
the key lessons from Crownswell. I think, you know, people
they often ask me like how hard it must have
been for me? To write this story and how dark
some parts of it are, and I of course agree,
(53:09):
and I needed to take a lot of breaks while
I did this work, absolutely, But the piece of it
for me that's actually incredibly hopeful, not just the amazing
people that you meet along the way in this book,
but also my belief that if you see where we
went wrong and you see how some of these systems
were set up, that now, in our current moments, so
(53:31):
many Americans of every background want a better mental health
care system, that this is a story that can provide
us a window like, oh, hey, this was a poor decision,
this wasn't necessary. Perhaps we should listen more to what
advocates and doctors are trying to tell us in this moment.
And I think that this when you look at Crowns Well,
(53:54):
through all these different eras, you can see windows of
opportunity and for change. And that to me is actually
a piece that, as strange as it may sound to others,
actually gives me hope.
Speaker 1 (54:06):
I can I can appreciate that we just it's having
the will to implement these changes. And to another question
here or lessons from the past, Yeah, right, that's separate. Well, Antonia,
this has been. I mean, such an enlightening and important conversation.
I am so happy to talk with you today and
I really appreciate you taking the time to chat.
Speaker 2 (54:26):
Thank you so great to join you.
Speaker 1 (54:47):
A big thank you again to Antonia Hilton for taking
the time to chat with me. If you enjoyed today's
episode and would like to learn more, check out our
website this podcast will kill You dot com. We're all
post a link to where you can find and Madness,
Race and Insanity in a Jim Crow Asylum. The paperbook
is now out, by the way, as well as a
link to Antonia's website where you can find her other
(55:09):
incredible work, including the podcast South Lake and Grapevine and
Don't Forget. You can check out our website for all
sorts of other cool things, including but not limited to, transcripts,
Quarantini and Placeibrida, recipes, show notes and references for all
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(55:32):
and music by Bloodmobile. Speaking of which, thank you to
Bloodmobile for providing the music for this episode and all
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Bryfogel for our audio mixing, and thanks to you listeners
for listening. I hope you liked this episode and our
loving being part of the TPWKY book Club. A special
(55:54):
thank you, as always to our fantastic patrons. We appreciate
your support so very much. Much well, until next time,
keep washing those hands, um.
Speaker 3 (56:13):
Um um
Speaker 1 (56:31):
Y
Hi, I'm Aaron Welsh and this is this Podcast Will
Kill You. Welcome to another episode of the tp w
k Y book Club, where I bring on authors of
popular science and medicine books to ask them all about
their latest work. This is truly one of my favorite
things to do because I get to learn about so
(01:04):
many fascinating topics like just this season alone, we've covered measles,
the history of the pelvic exam, phase therapy, the aerobiome,
and we've got more on deck for the rest of
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(01:25):
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you'll be able to spot a bunch of different TPWKY booklists,
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(01:46):
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(02:06):
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you can now find full video versions of most of
our newest episodes on YouTube. Make sure you're subscribed to
the exactly right Media YouTube channel so you never miss
a new episode. Drop. It is twenty twenty five. We
(02:27):
are a quarter of the way into the twenty first century,
and we are still failing in many ways to deliver
mental health care to those in need. Stigma, shame, dismissal, sexism,
and racism are all embedded in the way we view
and treat mental health issues, affecting who is deemed worthy
(02:49):
of receiving care and what type of care they receive.
And as the police have increasingly and inappropriately been called
on to respond to mental health health crises, Black Americans
and other people of color experiencing a crisis are disproportionately
more likely to be harmed or killed by police, imprisoned,
(03:11):
rather than given the help and mental health resources that
white Americans are more likely to receive. The roots of
these inequalities, which are ingrained in our current medical andcarceral systems,
stretch back generations. To make lasting and effective changes in
the way we approach mental health in this country, we
(03:31):
need to turn to the past to understand its role
in shaping are present in madness, race, and insanity. In
a Jim Crow Asylum, author Antonia Hilton explores the story
of Crownsville Hospital, a segregated asylum in ann Arundel County, Maryland,
built in nineteen eleven by its first patients, twelve black men.
(03:52):
Over the decades of its operation, during which it grew
into a compound housing thousands of patients, Crownsville became, in anyways,
a microcosm of the dynamics between race, mental illness, medicine,
and the civil rights movement playing out across the United States.
Expertly blending oral histories with archival materials, Hilton, who is
(04:14):
an Emmy Award winning anchor and correspondent for MSNBC and
NBC and New York Times bestselling author, presents a nuanced
and moving examination of an overcrowded, understaffed Jim Crow institution
that shaped the lives of those who lived or worked there.
Hilton also reveals how the shift in focus from asylums
(04:36):
to prisons in jails was reflected in Crownsville's operation. Madness
is an urgent, necessary, and powerful work that sheds much
needed light on the intersections between race, racism, and mental illness.
I'm really excited to share this conversation with you all,
so let's take a quick break and get started. Antonia,
(05:21):
thank you so much for joining me today.
Speaker 2 (05:23):
Thank you for having me. I'm so excited to do this.
Speaker 1 (05:26):
In your book Madness, you tell the truly haunting and
heartbreaking story of Crownsville Hospital, which is one of the
last segregated asylums in the US. How did you first
come across this story?
Speaker 2 (05:39):
Well, I first came across the story of Crownsville my
freshman year of college, and it was there's sort of
two origin stories I always tell people about how I
came to this place. The simple one is it's my
freshman year. I'm trying to figure out who I want
to be and what I want to study, and I
stumble into a class called Madness in Medicine that I
(06:01):
didn't even know was something that could exist, A course
all about the history of mental health care treatment in
the Europe in the United States, and I learn all
about the development of the asylum, the development of medications
to treat mental health challenges, and as I grow deeper
and deeper into the course, there's this thing gnawing at me,
(06:23):
which is that I'm learning about the history of mental
health care mostly from the perspective of European or white
American people. And I knew something was wrong with that,
not just from you know, basic instinct, but because I
have family members who were very deeply impacted by the
system themselves in the US history of mental health challenges
(06:43):
in my family, and so I knew that there were
black people, black patients, black providers who worked in these spaces,
who contributed and tried, and I just went looking for
a way to learn more about that at first. And
so I go looking to find out about the asylums
the institute US that worked with black patients, And what
I found was a system of segregated asylums built in
(07:06):
the decades after slavery came to an end in the US,
and many of them closed down, were the subject of scandal, burned, files, destroyed.
There's one asylum that a great grandfather of mine spent
some time in that has been turned into a kind
of Halloween theme park sort of experience. Yeah, I made
(07:28):
the same face when I first found that out. Wow.
And so in many cases I just kept hitting these
like dead ends. Okay, not much here, there's just a
paragraph about it here. And then I found Crownsville. And
Crownsville is unique and not unique in a number of ways.
Unique in that it is one of the only ones
that were part of this network, a segregated asylum with
(07:52):
existing records, living people and patients who had been at
this place, and a campus that is still standing even
to this day. In fact, it's in really the heart
of Maryland, in an Arundel County, and the county and
the state is engaged in a massive sort of rehabilitation
and reimagining project as we speak. And so there was
(08:13):
this opportunity to feel the place, to see it, to
walk through it, to talk and sit with people who
knew it intimately, and then to also petition the state
of Maryland for access to its records. And that was
unlike really any other opportunity. I'd say. There's one similar
place in Virginia called Central state that there's similar opportunity there,
(08:36):
but this was so rare, and so I just dove
in and I became obsessed. The longer story, and perhaps
the more true story, is that when I was eleven
years old, I had a conversation with my father about,
you know, cousins, and my cousins had just been visiting
(08:56):
our house and I asked my dad, you know, I
guess something must have clicked in my I had, Hey,
why haven't I met any of your cousins? Do I
know any of your cousins? You must have some And
he said, well, you know, there's an uncle who you
think is an uncle, but he's technically a cousin, but
you call him uncle. And that's something that I know
many people can relate to. And then he said, and
then you know, some of my cousins have lost touch
(09:19):
with them. One was incarcerated, and then one was killed
by a police officer in the middle of a mental
health episode, and we don't talk about him very much.
And that was my first time ever learning that my
dad had had a cousin named Maynard growing up, who
he had loved and admired. He kind of wanted to
be Maynard and in many ways, he actually did follow
in that cousin's footsteps. My dad is a lawyer. Maynard
(09:41):
was a lawyer when my dad was little, and he
developed schizophrenia and was killed by a police officer during
an interaction in public on the steps of a federal
building in Mobile, Alabama in the seventies. And I was
too young at the time to talk to my father
about that. I didn't really know how to ask good questions.
But then I became older and I asked a little
(10:03):
bit more. I became a journalist, I became a pest,
and I started to understand who Maynard was and just
how much his death had transformed my family. And I
think that in a way, for me, this story really
goes back to my childhood, to the discovery that there
had been all these stories in my family, these experiences
people who had tried and failed to seek treatment in
(10:25):
the system that set me on this path. Made me
so curious in my bones to try to understand this
that it set me up to be in a place
where then when I am this young student, it all
kind of clicked together. And so that's why I always
tell both of those stories, because there's this sort of
surface level story. But then there's like the what said
(10:47):
times has felt for me like this, like familial mission
I have been on almost like I don't know so
much that I had a choice. It just sort of
feels like all these things fell into place and they
were right, and they were the thing I had to do,
and that is what brought me to Crownsville and to
this unbelievable story.
Speaker 1 (11:05):
I mean, there are so many elements to the story
that you tell and in your book that it's not
just the effects of Crownsville Echo today, it's that they,
you know, have dictated, They have made the world that
we have today in terms of mental health care. And
I think it really helps sort of contextualize how today
we are still failing in many respects to provide adequate
(11:28):
mental health care. And I want to go through the
full story, but I want to touch on something that
you mentioned early on, which is the difficulty in obtaining
source materials. And I'd love to hear more about your
research method and your process for incorporating these different types
of source materials together, like which elements do you pull from?
(11:48):
What was that entire experience like for you.
Speaker 2 (11:51):
Oh boy, it was a lot it's short answers because
I was so young. So keep in mind, you know,
I begin this process as a literal teenager. I'm like
nineteen years eighteen, nineteen years old. There's a lot I
did not know about the world and how all of
this worked. And so my first real task at working
(12:14):
with I was really lucky to have Evelyn Hammonds at
Harvard as my PSIS advisor. I had her help and
some other people in the Harvard History of Science Department
really guide me through this. I don't know that I
would have gotten it done without them, but the process
of going through Institutional Review Board Human Subjects Research Approval
and getting the State of Maryland to give me permission
(12:36):
to come to the state archives and access records that
they typically refuse to share. In fact, it's a point
of contention for many people in the black community in
Maryland who have routinely asked for access to these records
and been denied it. And so I think I didn't
appreciate how hard it was going to be. I thought, Okay,
there's some rules on this website. I'm going to follow
all the rules. I'm going to take the tests they
(12:58):
tell me to take, and then they're going to let
me go. But you know, there were some politics that
got into the way and some people that dragged their feet,
and so it was helpful to have the backing of
that institution to come in and sort of apply some
pressure to make sure that I could get in there
and get my work done. And so that was to me.
(13:19):
I thought, like, Holy Grail, I'm going to go into
the state archives and everything will be there. I will
know everything about this place as soon as I can
get my hands on these primary source documents. And then
I finally do, and it is incredible. Let me not
downplay what's in there. I mean, there were monthly reports.
(13:41):
There were writings and letters that superintendents who ran the
institution had written to themselves or privately to other state leaders.
There were certain patient records, but whole lot of patient
records missing. And I very quickly realized this wasn't the
hoil that I thought it was going to be. That
(14:02):
most of what happens when an institution of that nature
closes down and people preserve what remains is the sort
of clinical perspective and the leadership perspective is preserved, but
the patient story that is not respected that's not maintained,
that's not preserved as as well. And in fact, as
(14:23):
I later learned in my journey, I didn't know this
at the time. Employees of the institution alleged that there
was a systematic effort to destroy a lot of the
patient stories because there was a fear from the state
in their view that perhaps lawsuits could come from that,
that it would be more trouble than it was worth.
And so I realized, even as a very young person
sitting there in the Maryland State Archives, oh wow, I'm
(14:47):
going to need to launch like a big oral history project.
I need to go talk to people. I need to
meet people. I'm going to need to make up for
the voices that are missing in this place and find
them elsewhere. And that it took a long time because
humans are human and you have to build trusts with people.
You have to call them, write them snail mail. I
(15:09):
mean a lot of the former employees they were at
the time and they still are quite elderly, and so
I couldn't text them and DM them on Instagram or something.
I had to really do some like shoe leather reporting work.
And in some cases there were some people I was
able to meet very quickly Pauler's for example, Paulers worked
(15:32):
at the institution for forty years, social worker who dedicated
his life to children at Crownsville. He was very quickly
willing to speak, but so many people had been affected.
I'd been traumatized in some cases by what they experienced
at Crownsville, and so it took a while to build
their trust. There are people in this book who took three, five,
seven years to decide to talk to me, and I
(15:54):
had to be really patient with that and respect that
there were people who didn't want to talk on the phone,
but they were willing to talk if I came and
knocked on the door and I sat on their porch.
And so the level of investment and patience that comes
with that, I really I grew into it in a way.
I started out as this young person who was just
calling people up, and I should be grateful that anyone
(16:15):
answered to a nineteen year old's phone calls. First of all,
let me say that. But then I became an adult
and a professional journalist, and I got the resources to
be able to do the sort of real like sitting
in the community and being present work, and that is
what transformed everything. I think those stories, those memories, they
(16:38):
are the richest part of this book. You know, the records,
they are fascinating, They are valuable. I worked with so
many of them in the story. But it's so helpful
to have the sort of sites, smells, sounds, and stories
from people who were so personally impacted by all this,
whether they were the patients or they were the providers,
and in many cases they really fill in critical gaps
(17:01):
or you know, the records in some cases actually confirmed
some of the stories that were found out in the community.
And with an institution like Crownsville, it's huge for anyone
listening who lives in the Maryland area, like it is
worth driving by and seeing this place because you'll get
a sense of just the immensity the number of people
(17:21):
who were touched by this place over the almost one
hundred years that it was in operation. And what comes
with that is there's amount of community rumor and storytelling
and all of that that you have to wade through.
And having the community and having the trust in the community,
and then having the records and bringing those complimentary pieces together,
(17:42):
it allowed me to find a way to tell a
story that had either been both sort of simultaneously pushed
under the rug but also sort of festered as a
mythological thing for a really long time. And it was
the ability to do both of those things that helped
me find the truth, the core of what happened there.
(18:04):
And I see the record, the sort of painstaking archival
and research process as being just as important as the
oral history endeavor to.
Speaker 1 (18:15):
Let's take a quick break and when we get back,
there's still so much to discuss. Welcome back everyone. I've
(18:37):
been chatting with Antonia Hilton about her book Madness, Race
and Insanity in a Jim Crow Asylum. Let's get back
into things. What emerges is this really rich, sweeping perspective
like the storytelling of asylums and the representation of asylums
that happens often in popular media like movies, is very
one sided, one dimensional, or just one perspective. And that's
(19:00):
one of the things I really appreciated about your book.
And I would love to turn to the beginning. Why
was this institution and other institutions like it? Why was
it built and how did its surrounding context both the
time period in which it was established and the location
that it was established in how did that shape what
(19:20):
it would become.
Speaker 2 (19:22):
The context is everything Crownsville is created. It is founded
in nineteen eleven, and this is a fascinating time in
the United States. Were a couple decades after the end
of slavery, and there have been these immense contradictions in
American society. I mean, black people have in some cases,
they've become lawmakers, they've started incredibly successful towns and communities
(19:45):
in places like Tulsa, Oklahoma, and they're gaining ground. But
then there is a massive backlash and backsliding that starts
to steal some of that ground back. And there's an
effort and a lot of that effort actually begin in Maryland.
A lot of people don't know this. You know, Maryland
passed one of the first segregation ordinances in the entire country,
(20:07):
if not I think the very first segregation ordinance in fact.
So there is this effort to try to put black
people back in their place. But there also is for
the black people who you know, haven't found the Tulsas,
who haven't maybe found their footing yet. There's this sort
of incessant writing going on in white intellectual circles. So doctors, lawyers,
(20:29):
politicians who are really obsessed with what they describe as
this problem of Negro insanity, Negro alcoholism, Negro waywardness. They
are observing that there are all these black people who
seem to be traumatized and struggling and unable to adjust
to life post enslavement. And you know, looking back on
(20:50):
it for us now, that perhaps doesn't seem so surprising
that people found that experience, you know, hundreds of years
of enslavement to be traumatizing for their families. But at
that time, you would think think they thought that everyone
would get over it in a year or two. That
just simply hadn't been the case. So they're writing in
these letters to each other or they're publishing in medical
journals these observations that were incredibly dehumanizing. On the other hand,
(21:15):
then they're expressing pity and saying, well, we need to
do something about it. We got to do something about it.
But what they decide to do is create a place
to treat them. But they must be separate from white
people because these antebellum attitudes that black people are inherently different,
they seeped into everything. I mean, I think people understand, okay,
separate Water Fountain, separate schools, but they forget I mean,
(21:38):
it went into healthcare treatment. It meant into basic conceptions
of how the mind in different people would work. And
so they make the decision that there need to be
these separate places for treatment, and Maryland takes it one
step farther. They decide that they're going to create this asylum,
but they don't really want to pay for it, and
(21:59):
they're going to ask, not ask, They're going to force
these patients to build it for themselves. So it begins
with twelve black men who are brought from almshouses, poorhouses
around the state, brought into a forest and if you
know the Maryland area, it's sort of the modern Bacon
Ridge natural area, and there's nothing there, nothing, not a
(22:19):
place to sleep, no cabins, and they are told they
have to get to work, build yourself an asylum, move railways,
move tracks, construct roads, clear ground. I mean really monumental labor.
They're working side by side with contractors hired by the state,
but the patients did an immense amount of the backbreaking,
(22:42):
really physical labor. And weeks go by as they're doing this,
and they bring new patients in and new men in
and actually also boys. There are state records describing you know,
putting boys who are about ten to twelve years old
who are disabled, physically disabled to work and being proud
(23:05):
that they were able to get them to carry you know,
pails of water or other items around and get them
to contribute to this effort. And the sort of tone
is always that they should be grateful that they're given
this work, that it must make them feel better, you know,
and that once this project is done, they'll march into
the rooms that they just built and they'll become its
(23:26):
first patients. So that is how Crownsville begins, and that
is the racial and political context at the time.
Speaker 1 (23:35):
How was mental health like was mental health a concept?
How was mental health different than mental illness? And what
were the prevailing ideas around treatments or therapies and you know,
what options were available to for instance, a black person
in nineteen eleven in Maryland that if they were experiencing
(23:57):
a crisis, where could they go? Could they go anywhere?
Speaker 2 (24:01):
I really appreciate this question. Actually, you might be the
first interviewer to ask me that in that way, because
I think it gives me the chance to make an
important point which is that I think often, you know,
in twenty twenty five, we look back at a time
like nineteen eleven and we think, well, people just didn't
know anything, like it was all pretty horrible. And look,
(24:23):
a lot of the mental health care treatment, the majority
of what was available was terrible for everybody. I mean,
if you actually talk to psychiatrists and biochemists and to
therapists and people who work in the space today, they'll
still tell you that we may be in the dark
ages of understanding how the mind works at this current moment.
So certainly nobody's going to argue that what was available
(24:43):
in nineteen eleven was incredible. And you know that there
were quick fixes all around, No, not for anyone, But
there were ways in which leaders made very deliberate decisions
to give people of color the absolute worst of what
was available. You know. For example, they knew that tuberculosis
(25:04):
was an incredibly dangerous disease that impacted people's physical and
mental health, but they were careful to create separate, quarantined
wards for that. At all white institutions, they refused to
do that. However, at Crownsville, they knew that this disease
would kill or physically and permanently disable all kinds of
(25:25):
people in these in Crownsville, but they allowed it to
fester anyway. That was a price, a sort of just
a reality they were willing to accept, despite writing and
openly knowing that to do the opposite was the right
thing for another set of patients. And the other interesting
thing I should say too, is a lot of these
(25:45):
therapies are complicated to talk about because they may sound
horrible at first, but there are clinical arguments that have
been made for them. For example, electro shock. A lot
of people horrified by the concept of electroshock, but there
are still people doing electro shock to this day, and
there are patients that will tell you that they love it,
and so you know, while at Crownsville there are a
(26:05):
lot of stories of abuse of patients through electroshock, there
are stories of clinicians believing that it was a valuable
tool that helped them gain insight and make treatment breakthroughs
with patients at places like Crownsville too. Hydro Therapy is
another example. Hydro Therapy is a tool that for some
patients could be incredibly relaxing. It was the experience of
(26:28):
being submerged up in water in a tub sort of
up to right under your chin, and you would be
either an incredibly hot or incredibly cold water for a
period of time. That period of time could be a
couple hours, it could be up to three days. At Crownsville, now,
spending a couple hours in a very warm tub for
some patients was apparently in some cases very relaxing. Spending
(26:51):
three days in a very hot or a cold tub,
some would call that torture. And so every single one
of the sort of modalities available, you can pause, or
you can do the reading and see a completely different
way of looking at its application and the potential for harm.
(27:13):
And so there's sort of the baseline story of what
was available and how difficult and how dark the treatment
of the mind was at that time. But then there's
also just sort of the need to understand that as
you look at the different kinds of facilities that always
what you saw was the same pattern repeated, not just
in Maryland, but certainly that's the place that I studied,
(27:35):
that the black patients were going to get the worst
of what was out there, and we're going to have
the fewest sort of clinicians and aids available to support them.
I write at one point about records that I found
that showed that as the state rehabilitated a bunch of
the different asylums in the state, that they sort of
(27:56):
consciously made the decision to build less therapy spas at Crownsville.
So sort of this idea that there was going to
be room for patients to even just have space to talk,
to reflect, to work with and be in conversation with
a provider. You see the way in which sort of
attitudes are reflected in expenditures and structural decision making. I
know people don't love talking about structural racism anymore, but
(28:21):
you see a lot of it, very obviously in the
story of Crownsville. And so it's complicated because there are
these moments in this story where people are able to
do genuinely great work with patients at Crownsville, especially after
integration and more members of the community are able to
get the chance to take care of people who look
like and who know them. But there are also there's
(28:44):
also the element of horror. There's also an absolute reality
of abuse, and all of those things existed and coexisted
and could happen on any given day at the very
same time.
Speaker 1 (28:57):
Let's take a quick break here. We'll be back before
you know it. Welcome back everyone, I'm here chatting with
(29:17):
the wonderful Antonia Hilton about her book Madness. Let's get
into some more questions. The way that this plays out
is such a nuanced way, where you have these prevailing
notions about how the mind works, how mental illness works,
and then also you have this racism that's baked into
so much of the way that that is informing that
(29:37):
a lot of the physicians, for instance, who are providing
the treatment and so on, and then and of course
funding and all of that. And initially it seems like
for at least a period of time, Crownsville's predominant role
was not too necessarily, or maybe it was in combination
to provide care for those with mental illness, but also
(30:00):
to exploit those individuals for their free labor. How did
this factor into how long someone was held at Crownsville
or was lived at Crownsville, And when did awareness of
this sort of mistreatment or these instances of mistreatment seep
into the surrounding communities.
Speaker 2 (30:21):
The question of exploitation is a really important one because
it is there from the very beginning, I mean, the
story of its creation. It's almost like when I tell
people the story, it almost sounds like biblical or mythological
to them that these twelve men are in the woods
and they hear the news that they have to build
themselves a hospital. So the exploitation begins before the hospital
(30:44):
has any sort of physicality to it, and then when
the hospital opens and its operations start, that is really
just the beginning of very long workdays for the majority
of the patients there. Unless you were essentially completely physically disabled,
you were expected to offset the cost of your own
care for many decades, the first essentially three four decades
(31:06):
at Crownsville. There is this massive pressure on patient labor
there in areas that were unusual to so in the
twentieth century, there was a very common concept actually even
before that, of this idea that having vocational training for patients,
(31:27):
for people struggling with their mental health would be good
for them. It would mean that when they get out
they get great jobs or they have an apprenticeship, they
have opportunity, or at least they can be helpful to
their families if they're staying at home, and so Lots
of asylums had jobs, programs or chores that patients needed
to do, and Crownsville was no different in that respect.
But the hospital had an entirely other layer of labor expectations.
(31:52):
Unlike anything seen in Maryland or really most of the
institutions I've ever studied, Crownsville expected patient to run a
highly modern and productive farm with modern irrigation practices. They
farmed tobacco, they worked with cattle. Women were expected to
(32:14):
basically constantly be working with food and produce, or in
the kitchen or in the laundry. And it was to
such a powerful extent that this is remarked upon consistently
in state records, really as a point of pride that
we're able to keep the cost down at this place
because we made the patients run the place themselves. They
(32:35):
were proud of how much they were able to get
them to do it. And then even they take it
again another step too far. They are extracting from creative patients.
So people who create rugs or did basket weaving, they
start to sell their goods, and none of that money
comes back to the patient themselves. It's used again to
offset the costs of their care. They send items that
(32:57):
patients at Crowns will made out to competition, and the
superintendents would display and brag about them as if they
were almost theirs. And so there is this sort of
constant air of exploitation there, and it doesn't start to
shift until really, I mean, I guess it depends on
(33:18):
your idea of what a shift looks like, if it's
the rumor mill, if it's awareness in the community. The
black community became aware of a lot of this very
early on. There were a number of patient murders. I
write about one, the father of civil rights icon Polly Murray,
her father William Murray, murdered by an allegedly pretty openly
(33:38):
racist guard at the hospital. Stories like that they spread
among black community members of Annapolis and Baltimore. They didn't
necessarily get the attention they perhaps deserved in the papers
like the Washington Post or Baltimore's Sun, but they certainly
were known about. But real action begins, say in the forties,
(33:58):
when there are these sort of budding civil rights movements.
There are lawyers and growing budding associations like the NAACP
that are starting to sort of demand access, demand meetings
with state leaders and the superintendents of Crownsville and get
in there and actually start taking testimony from patients. And then,
(34:21):
to give a little credit to my field, there are
reporters who start asking questions. At all the major papers,
there is a series of expose as, but there's also
some incredible work done. I have to shout out the
Afro American newspapers because those reporters consistently published diary entries
of patients on the first pages, unlike anything any of
the other papers were doing. And they allowed patients to
(34:43):
tell their own stories and their own voices, and weren't
always taking the word of say the police or the
superintendent above theirs. And so there's a lot of richness
there in the record that you can find by looking
at some of the alternative or minority media at that time.
And so that's when the sort of consciousness that guests
(35:04):
starts to shift is in that period in the forties,
and in a way it's no surprise America is engaged
in a horrendous world war. The hospital is starting to
receive and welcome in Jewish men and women who are
fleeing the Nazis and who are coming to restart their
lives in the United States, they come to work at
places like Crownswell, and they too are outraged by what
(35:26):
they see there because they've seen this, They just escaped
a system of extinction, and now they come to this
place and they see the patient labor and the exploitation
for what it is. And so you have all these
factors that are coming together in that period that are
leading to these new coalitions that are getting ready to
transform this place.
Speaker 1 (35:46):
This broader shift not just within the recognition of Crownsville,
but this shift in the mid twentieth century that you
describe in the way that the general public and medicine
begins to see mental health and psychiatric hospitals these views.
Of course, the shifts and these views are not consistent
across the race of the patients, right, And you point
(36:08):
out the differences in this framing where white patients are
said to well, well, we need to rehabilitate, but black
patients it said, oh, well we need to manage. How
did this play out at Crownsville.
Speaker 2 (36:22):
This is again actually where some of the most valuable
records were the work of reporters, because they would talk
to community members and kind of publish their unvarnished thoughts
about what should be done about places like Crownsville or
similar peer white institutions like spring Grove or Springfield in
the state. What I found was that just as you mentioned,
(36:43):
there's this movement after there are scandals in the asylums
and reporters are starting to get the story out there,
lawyers are starting to make demands. There's this growing movement
in the United States that begins in the forties and
really extends for decades onward to rein best in community care,
to bring people home, to have more empathy for the patient,
(37:04):
to be willing to hear their side of the story,
and to share their narratives in the paper, in media
and movies. Really there was a sort of explosion. But
then what I found is that when it came to
black patients, the communal response was very different. There was
a fear about release, there was a fear about what
(37:25):
it would mean to welcome them back into the community,
and that often reporters in my field then they made
a lot of mistakes. They over exaggerated and sort of
misreported the extent of for example, escapes or riots at
a place like Crownsville, as compared to what was happening
at pure white institutions. And I found records of even
(37:46):
superintendents who know none of the patients, would have described
as their ally. They would acknowledge that the crowns will
the amount of violence or escapes at that site were
being sort of unfairly highlight or featured in the papers,
even when pretty much equivalent events were happening elsewhere. I
(38:06):
spent some time going through just some of the language
the adjectives used by reporters at the time, too, that
when they would talk about a white patient who escaped,
they would often describe sort of the person's melancholy, how
fearful they were. I remember, I don't think I included
in the book, but I remember reading one paper describing
a white male patient escaping one institution, and the paper
(38:29):
was kind of making jokes about the red fluffy slippers
that he escaped into the woods wearing. Whereas and I
do include these in the book. I write about some
of the young black male patients who are written about
as though they are any minute now going to come
into the suburbs surrounding the institution and rob rape and
(38:49):
terrify people. And there are descriptions of people saying, you know,
after they've heard about an escape, that guns are going
out onto porches tonight, and people are sort of fantasizing
about this fear of their wives being left home alone.
And there's this sort of juxtaposition always between sort of
white domestic life and the threat of the people inside
(39:11):
Crownsville again, even though at the same time, the same
number of patient escapes are pretty routinely happening at pure
white places as well, And so there is a perception
that follows then, of course, and what follows from the conversation,
the cultural conversation, the perception is political action. People start
(39:32):
advocating to build a wall around Crownsville anyone, I don't know.
Maybe they advocate for morelock and key policies. They want
to bar patients from being able to visit communities. There's
this massive carceral push to keep them behind bars at
all costs, even as clinicians keep saying, we know from
(39:55):
the evidence from the work we're doing with these patients
that what they need is actually more community support. We
need to be able to hire more people they need therapists.
There are patients every week getting zero time with therapists
or psychiatrists at the hospital. Basically they're just like sleeping
there and working there all day long. They're not actually
getting the treatment and rehabilitation that this place was supposed
(40:17):
to provide. And so there's the people who sort of
know the people in the place begging for one thing,
but the community, because of what they've grown to fear
and believe, pushing for the exact opposite. And in many cases,
the community and the sort of people filled with this
false perception they went out and one of the tragedies
(40:41):
of Crownswel, and I often use Crownswel to help people
understand concepts around structural racism and sort of the ways
in which our past informs always our present moment is
that because of what happened in Crownzell's founding, that the
state always wanted to spend less money on it. They
never invested in its building completely, they never invested in employees,
(41:05):
they never invested in making sure there were good doctors
and clinicians there. They didn't want to build the proper
amount of therapy space. They barely had food and soap
available during World War Two, when patients there were literally
suffering and dying. Even when this sort of civil rights
movement gets some wins, there's integration and there are changes coming,
(41:26):
and there's sort of new standards and rules by which
all these places have to operate. Crownsville is operating at
a deficit. They're never given back the money they were
never provided, and so all these new sort of institutional
and legal and healthcare care related laws and regulations come
into place. There are these high expectations of the place
(41:47):
after integration, like Okay, let's see what you all can do.
But they don't have money. They're operating with an institution
never built with what it needed to properly survive, and
so they end up kind of stuck in this heads
you lose tails, you lose situation, and it's heartbreaking for
(42:08):
the institution and it haunts it from the period we're
talking about all the way until it's closure in two
thousand and four.
Speaker 1 (42:14):
This period of time too is as I find this
so interesting, this shift in the framing of how we're
viewing mental illness and then also sort of the weaponization
of diagnosis that still happens today, where you get these
shifts in or these changes in the way that certain
conditions are labeled or you know, for instance, schizophrenia is
(42:37):
one that you discuss in your book. And of course
there's another book, the Protest Psychosis, that goes into this
as well, where it starts out as this sort of
this diagnosis of mothers, homemakers who are burnt out, and
then it transforms into this opportunity to pathologize young black
men in particular, especially during this period of time. What
(43:00):
was happening at Crownsville as far as that goes, or like,
was that bleeding into there as well?
Speaker 2 (43:06):
Oh? Absolutely. And I have to give a shout out
to Jonathan Metzl, the author of The Protest Psychosis. He
was so helpful to me when I was an undergraduate
trying to learn how to do all of this stuff,
and we have been so supportive of each other's work since,
and so I cite him a lot in the book,
and that's no mistake, Like I couldn't have done a
(43:27):
lot of this work without his help and his feedback
at many points. Crowns Will absolutely reflects that story. You
see it in the records, but you also see it
in really and what I found most interesting was the
recollections and the testimony of the people who were there.
There's this really just fascinating transition coming out of really
(43:48):
the civil rights movement where you start to see all
of these clinical changes that they're starting to change that
labeling as you just spelled out. So schizophrenia is becoming
more of something that is about paranoia and aggression and
all of these assumptions around black men and masculinity, and
it's shifting from being sort of pictured or illustrated as
(44:10):
a disease mostly of I guess, being withdrawn into yourself,
and so it's sort of seen as this explosive thing.
I even show in the book some examples of psychiatric
ads and ways in which the conversation and the depiction
of who suffers from schizophrenia shifts at the same moment
that these movements these protests are happening. There's one psychiatric
(44:32):
ad that I'll never forget that depicts a black man
like hanging from fiery bars and looks like he's in
the middle of a protest that's burning some kind of
city to the ground. And he is the image that
is accompanying a medication to treat schizophrenia and other diseases.
And so you see that and if you're a person
of that time. That is absolutely when you're talking about
(44:54):
a time in which there were massive protests. I mean
Martin Luther King murdered and that impacted Crownsville. People there
process that in real time, staff members, patient, family members,
they attended the march on Washington. I mean, all of
this is interrelated. It's all part of the cultural context
to the story. So you see it from the clinical perspective,
(45:16):
but also I enjoyed hearing the memories of people who
could describe it for you less as this sort of
academic pattern and more is just the real thing that
they saw every day at work. I spent a lot
of time with this psychiatrist who actually still lives and
works in ann Arundel County, Maryland to this day, named
doctor Brian Simms. He was one of the first black psychiatrists.
(45:39):
He really helped pioneer trauma informed care at Crownsville. And
this is in the latter part of the book, and
he writes about seeing police bringing a boy who's about
six years old to the hospital in a karate uniform.
He's misbehaved in karate class and he's brought there. He
and many other described to me seeing patients you chained
(46:02):
to polls while they waited to find out where they
were going to be sent. Within the institution, the sort
of constant flow of court committed patients who judges sort
of decided were one week maybe they would go to
the jail, the next week they were fit for Crownsville,
And how doctors like him had to get on the
phone and battle it out with judges and try to
(46:23):
explain to them what was and wasn't appropriate, what was
a clinical necessity and what wasn't, and that it was
an exhausting, sort of unpaid part of their labor, and
that they saw a lot of it as incredibly racialized,
that kind of the second they saw a black person
with pain and confusion and who had perherhaps committed a
low level crime, that to them there was this sort
(46:46):
of fear of derangement and a desire to have them
stuck at a place like Crownsville. And that was really
heartbreaking for the people who worked there. And the way
that they tell those stories, they capture it so much
better I think than a journalist or an acade even can,
And so I tried my best to retell those stories
in their voices, but you absolutely see it play out.
(47:06):
And the doubly heartbreaking part is that those same doctors
then respond by trying to create sort of a community
based solution. So, Okay, we're going to create a program
where we ourselves drive to visit our patients out in
the community. We're going to make sure they stay on
their medications. We're going to make sure they don't go
back to court that they because a lot of patients
they end up on what's essentially sort of the mental
(47:28):
health equivalent of like probation, where any missed appointment could
send you back to the hospital. And so these doctors
are committed to trying to get people out of that cycle,
because I mean, who among us hasn't missed a doctor's
appointment to be told for five years that you can
never miss an appointment and put people at a meense risk.
So they sort of put a lot aside in their
(47:49):
day to day jobs and drove out there into Baltimore,
into all these other neighborhoods to make sure their patients
made it anyway, and after seeing immense success, seeing the
recidivism drop precipitously, they're told by the state that this
isn't a good use of their time, and that the
program needs to disband. And so you saw that lack
(48:10):
of compassion and the way in which the attitudes you
have about a certain community create a kind of permission
structure and a sort of attitude from the top down
where anything that would actually solve the problem you claim
to be so alarmed about isn't worth spending money on.
But the one thing consistently we're willing to do is
behind bars, behind bars, behind bars. And it is absolutely
(48:35):
a part of the Crownsville story, and it's something that's
stuck with so many of the people who worked there
for decades onward.
Speaker 1 (48:41):
Crownsville acted as almost like a place of dual purpose,
where you have it as a psychiatric facility on one hand,
but then this unofficial detention site on the other. And
this also, as you describe in your books or plays
out on the national scale, where you have this decline
in psychiatric hospitals, just as you see this expansion of
the prison system in the US. Can you tell me
(49:03):
a little bit more about that.
Speaker 2 (49:05):
Yeah, what I'm arguing in that section of the story
is really that it's not such a simplistic story where
the asylum disappears and everyone goes to prisons. But that
you have to see these institutions as being in conversation
with each other and as sharing DNA, being part of
(49:26):
the same genealogical timeline, and that it isn't a coincidence
that at the moment that we are starting to disband
this massive institution that at one point was the dominant
institution in the United States and the mid twentieth century,
the asylum was much more prevalent and powerful. There were
more people there than there were in our prison system,
(49:49):
and so you see the decline of that place and
this explosion in the other And Crownswell is a fascinating
window into that because again it's you can see how
it worked in real time and in day to day
human interactions. I write at one point about a report
that breaks down what was essentially going on inside of
(50:14):
peer white institutions and Crownsville, which at that point had
been desegregated but was still majority black, as they were
trying to transition patients out of the institution back to
the community. Sort of a simple government study trying to
look at what was available to those people in those
different groups as that process unfolded. What they found was
(50:35):
that at a peer white institution, there were vocational trainers available,
There were counselors and teachers and family members present at
these hearings, essentially where someone would get approved to go
home or not go home, and they would be connected
with opportunities and resources afterward. The report found that at
(50:56):
Crownsville there were juvenile probation officers present, there were often
no educators, nobody hiring out in the community, no vocational support,
and so there was much more common that there would
be someone who had a tie to the prison and
jail industrial system, and a lot less likely that there
would be somebody who was about to connect that person
(51:19):
with a bright future, a job opportunity, and an appointment
to make sure that they stayed on their care schedule.
And so even then, as this is happening in real time,
there is a knowledge that it's not happening the same
for everyone. This whole idea that we had become so
empathetic and interested in supporting patients and bringing them home
(51:43):
was not applied evenly to all populations, and so it's
no surprise then that our prisons and jails are full
of black people, many of whom clinicians CEOs will tell
you they think actually need mental health care, treatment and
(52:04):
support and are likely regressing in a car soral setting
like that. And it's the kind of maddening moment we're
living in right now. I mean, I think about it
a lot, in particular as we look at what's unfolding
in Washington, d C. And we see this big push
to just get the homeless out of there, just push
them out, like the President basically saying that he doesn't
(52:27):
care where they end up and where they go, but
they can't be here. And the idea that well, okay,
you either find yourself a shelter or something you're gonna do,
or you're gonna end up in jail. That attitude, it
came from somewhere, and we saw all these shifts, and
in many ways I describe basically the black patient as
(52:48):
sort of the lynchpin that held these negotiations together, through
which you can see how so many of these decisions
and disparate actions were taken. And that's really one of
the key lessons from Crownswell. I think, you know, people
they often ask me like how hard it must have
been for me? To write this story and how dark
some parts of it are, and I of course agree,
(53:09):
and I needed to take a lot of breaks while
I did this work, absolutely, But the piece of it
for me that's actually incredibly hopeful, not just the amazing
people that you meet along the way in this book,
but also my belief that if you see where we
went wrong and you see how some of these systems
were set up, that now, in our current moments, so
(53:31):
many Americans of every background want a better mental health
care system, that this is a story that can provide
us a window like, oh, hey, this was a poor decision,
this wasn't necessary. Perhaps we should listen more to what
advocates and doctors are trying to tell us in this moment.
And I think that this when you look at Crowns Well,
(53:54):
through all these different eras, you can see windows of
opportunity and for change. And that to me is actually
a piece that, as strange as it may sound to others,
actually gives me hope.
Speaker 1 (54:06):
I can I can appreciate that we just it's having
the will to implement these changes. And to another question
here or lessons from the past, Yeah, right, that's separate. Well, Antonia,
this has been. I mean, such an enlightening and important conversation.
I am so happy to talk with you today and
I really appreciate you taking the time to chat.
Speaker 2 (54:26):
Thank you so great to join you.
Speaker 1 (54:47):
A big thank you again to Antonia Hilton for taking
the time to chat with me. If you enjoyed today's
episode and would like to learn more, check out our
website this podcast will kill You dot com. We're all
post a link to where you can find and Madness,
Race and Insanity in a Jim Crow Asylum. The paperbook
is now out, by the way, as well as a
link to Antonia's website where you can find her other
(55:09):
incredible work, including the podcast South Lake and Grapevine and
Don't Forget. You can check out our website for all
sorts of other cool things, including but not limited to, transcripts,
Quarantini and Placeibrida, recipes, show notes and references for all
of our episodes, links to merch our bookshop, dot Org,
affiliate account, our Goodreads list, a first hand account, form,
(55:32):
and music by Bloodmobile. Speaking of which, thank you to
Bloodmobile for providing the music for this episode and all
of our episodes. Thank you to Leana Squalacci and Tom
Bryfogel for our audio mixing, and thanks to you listeners
for listening. I hope you liked this episode and our
loving being part of the TPWKY book Club. A special
(55:54):
thank you, as always to our fantastic patrons. We appreciate
your support so very much. Much well, until next time,
keep washing those hands, um.
Speaker 3 (56:13):
Um um
Speaker 1 (56:31):
Y
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