New book ‘Madness’ documents the racism of a Jim Crow-era mental health facility

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• Amna Nawaz:

  Crownsville State Hospital in Maryland was one of the last segregated mental asylums in the country and it operated for some 93 years. Thousands of Black patients came through over the years and many of them died there.

  NBC News correspondent Antonia Hylton began looking into the facility a decade ago during her first year of college. I spoke with her recently about her findings which, she details in a new book, "Madness: Race and Insanity in a Jim Crow Asylum."

  And I asked her why she wanted to tell this story.

  Antonia Hylton, Author, "Madness: Race and Insanity in a Jim Crow Asylum": It was my freshman year, and I stumbled into a course about the history of psychiatry, and I became obsessed.

  On the one hand, it was an academic obsession, a passion for the history of mental health. But there was also a personal aching and longing, I think, because I come from a very big, tight-knit family. I'm one of seven kids.

  But the one topic that always seemed off-limits when I was growing up was mental trauma and mental illness. And that's because I came from a family with a long history of dealing with those issues and loved ones, relatives who had spent time in institutions not unlike Crownsville.

  And so when I finally was out of my own as a young adult, it was my moment to explore, to try to find myself, my family, a bit of my history reflected somewhere. And I stumbled across — upon a footnote about Crownsville Hospital.

  And I didn't know then what this would become, but I knew that I had found something really special and really important, a key piece of Black history, of the history of psychiatry. But, really, it's an American story, a story that I think implicates all of us.

• Amna Nawaz:

  Tell me about what you uncovered, though, because you go on, as you mentioned, a decade-long journey uncovering documents, talking to people who work there, family members of folks who were at Crownsville as well.

  You basically document the story of a chronically underfunded, perpetually short-staffed facility surrounded by hostile neighbors subject to the same overt and violent racism as many other institutions and resources for Black people at the time. What was the impact of that on the people who were there?

• Antonia Hylton:

  Crownsville is this complicated institution that comes to reflect all of these evolving battles in our country in its early years, founded in 1911.

  And one of the things that was most shocking to me that I found when I first embarked on all this research was that this is the only hospital in the state of Maryland and quite possibly the only hospital in the history of the United States that forced its own patients to build it from the ground up.

  And this is because doctors at the time had very particular beliefs about Black people and their minds, their mental well-being. Many of them believed that emancipation was a mistake and that Black people weren't able to handle freedom, and that this rise in mental illness, in emotional disturbances that they were witnessing in the years after emancipation, they figured, well, it must be because they can't handle freedom.

  No one seemed to pause and ask, well, what effect might have enslavement had on Black Americans? And so they create these segregated institutions from the very beginning with this idea that Black people are different and therefore need to be treated differently, and that the solution, part of the therapy, the treatment is to put them back to work.

  And so these patients in 1911 are brought into a forest, and they're not just carrying some water or sandbags and helping some contractors out. They are pouring cement. They are moving railways. They are building massive structures from the ground up. And they are working side by side through the day and night with contractors and electricians to build a hospital that, once it's complete, they're going to be marched inside and they're going to become its first patients.

  And so I often share that story with people so that they understand that this is really the beginning, the genesis of a story that comes to reflect so much of how Black people are then treated. And the hospital's founding, it represents that moment after emancipation. It comes to represent fights over integration, civil rights, the fight for Black people's complete and honest representation and participation in this country.

• Amna Nawaz:

  You document a number of horrific, quite frankly, accounts, acts of violence in Crownsville, abuse of patients, inhumanity that really just takes your breath away, but there's also moments of bravery and real humanity, in particular from some of the Black staffers at the facility who really fight for people who aren't getting treatment.

  Does any one person or any one story stick with you?

• Antonia Hylton:

  Oh, man, there are a few.

  There's this group, this clique of Black women who arrive in the 1950s and 1960s, and they're some of the very first Black people that get the opportunity to work at Crownsville. For its first several decades, it's a hospital that's all Black patients and exclusively white employees.

  Then integration comes, and, slowly, more and more Black local community members are able to get jobs and to treat people who don't just look like them, but in many cases went to school with them, rode the bus with them, lived down the street from them. They notice that many patients don't have clothes, so they go home and they gather their own leftover clothing, and they bring it to the hospital.

  They notice that some of the male patients don't have belts and their pants are falling down all day and they're not able to live with dignity. So they go and they make their own makeshift belts, very simple acts like that for decades it seemed no other employee had thought to do.

  And so they start to transform the culture of the hospital just because they see those patients as human.

• Amna Nawaz:

  You dug into your own family history as part of your reporting as well and the reluctance, as you mentioned, to talk about a lot of the mental health issues through the generations.

• You write this:

  "In my family, the stories range from regular depression to anxiety to alcoholism and schizophrenia. We were warned about how much diabetes there was in our family medical history. It would have helped to know about the number of mental breakdowns too."

  How has this changed how you look at the stigma surrounding mental health conversations, particularly around communities of color, where there are fewer resources and these are often issues we just don't talk about?

• Antonia Hylton:

  It gave me more empathy, because there was a time when I was very angry at some of my family members. I had tried to have conversations with them.

  I remember being in high school and asking my parents if I could have a therapist, because I was feeling very down at school. And they said, no, that's not something that Black people do. Therapists don't treat Black people well. You can't trust them.

  And I felt like they'd shut me down and turned me away, and they were old-school and they just didn't want to hear about my life and my experiences.

  But once you reckon with this history, when you see the way in which they were excluded from real therapy and mental health care treatment, or when they did access it, how harmful it at times could be, you start to understand why maybe did my grandparents and my parents think this system wasn't for them, that it wasn't safe for their children to engage in it.

• Amna Nawaz:

  The book is "Madness: Race and Insanity in a Jim Crow Asylum." The author is Antonia Hylton.

  Antonia, thank you so much.

• Antonia Hylton:

  Thank you.