The racist misinformation infecting systems of care
Journalist Antonia Hylton exposes how a centuries-old myth has taken hold in the U.S. today.
Chatbots and artificial intelligence tools gobbling up toxic social media and spitting out questionable, polarizing information may prove a doozy for people trying to discern good intel from bad. But misinformation that creates confusion and sows division is nothing new. In fact, America is built on it. For centuries, powerful men have spun myths into language and laws that shape U.S. culture. Primary among them: that Black people are biologically different than White people and, therefore, less deserving of care.
There are no biological differences by race, yet an inaccurate, insidious narrative about White supremacy has played out in U.S. policies affecting health coverage and access to care. To build better political, social and economic systems, we must expose the misinformation they’re based on.
Journalist Antonia Hylton does this in her new book, Madness: Race and Insanity in a Jim Crow Asylum. The Peabody and Emmy award-winning journalist sifted through white-washed archives and interviewed aging sources to tell the 93-year-old history of Crownsville Hospital, one of America’s last segregated mental health asylums. I recently spoke with Hylton at the Sozosei Summit to decriminalize mental illness in Philadelphia, where the philanthropic group posed the question, “Do we truly believe that all people deserve access to mental health care?”
The answer is “no,” according to U.S. mental health disparities and the way the prison system is used to “manage” the mental illness of too many people of color. So, I asked Hylton what myths have contributed to where we are today. Our conversation has been edited for clarity and brevity.
Kate Woodsome: You spent a decade reporting Madness. What did you uncover?
Antonia Hylton: It is a strange and almost unbelievable tale, but it is also a very American one. On March 13, 1911, officials in Maryland marched 12 Black men suffering with mental illnesses or developmental differences into the heart of the woods in Anne Arundel County, right near what we all know now as the capital, Annapolis. Those men did not arrive to find a hospital, a ward, a bed, a place to rest. They found a field and a doctor named Robert Winterode.
Winterode told these 12 men they had a new and unpaid job. They were going to spend the next three seasons of their lives building their own institution. They would clear the forest, move railways, construct a foundation and, ultimately, erect a system of large brick buildings that still stand more than a century later. When they finished, they were marched inside and became this institution's first patients. It was Crownsville Hospital, formerly Maryland's Hospital for the Negro Insane. And this hospital is the heart of madness.
A place like Crownsville, a segregated hospital, came to be because of a lie, a myth, a story told for decades by leaders, not just in Maryland but across the United States. They were debating theories about the minds and bodies of Black people in the years after emancipation. And they were writing in journals and medical studies that there was a surprising amount of struggle and strife in Black communities in the years after emancipation.
It might seem obvious to us now, why somebody might struggle after hundreds of years of enslavement, but a popular theory back then was simply that Black people were fundamentally different from everyone else. It was this idea that Black people are inferior, that our health is measured differently, that we deserved less care and, therefore, should be sent to substandard facilities across the United States. The myths that crystallized as this institution was built continue to affect not just that hospital, but this entire system to this day.
Kate Woodsome: To understand how this myth hardened into a reality, it's helpful to look at the language and theory of how it came to be. Let's travel back to 1851 and the work of a physician named Samuel Cartwright. What was his contribution?
Antonia Hylton: Samuel Cartwright was working at the University of Louisiana, where he coined the pseudoscientific term, “drapetomania,” the disease that caused Negroes to run away. A lot of doctors argued that emancipation would be a mistake because Black people were so fundamentally different [than White people] that freedom would cause them to essentially unravel. Even after Samuel Cartwright was gone, there were physicians who came to work at places like Crownsville and who founded other institutions, like Central State in Virginia, and were involved in the American Psychiatric Association who bought into the same myths.
Kate Woodsome: Let’s slow down a moment. Drapetomania was a medical term to explain why Black people seeking freedom were mentally disturbed. The idea was that a Black person was healthy while enslaved because they were cared for by their masters, so they must have been sick if they wanted to get away. If that was the diagnosis, what was the treatment?
Antonia Hylton: More labor. The head of Virginia's mental health commission and a member of the American Psychiatric Association came up with a framework about how we should provide mental health care to the races. It was pretty simple: White people and Black people are different, so they should be in different institutions. And health for Black patients means a return to their natural order.
When you believe that the natural way of doing things is the antebellum social order, that means that health for Black people will be measured by how much labor they do, how much time they spend outside doing agricultural production. The patients at Crownsville were forced to do unbelievable amounts of labor to offset the cost of their own care, something no other group of patients were asked to do in Maryland or anywhere else. They ran a massive, highly productive farm. They constructed an irrigation practice on about 1500 acres of land. They created and sold rugs, baskets, woodworking. They were sent out for no pay to work on private farms and businesses. And they were told this was their therapy.
Mental institutions have long had work programs to help people find a job when they’re rehabilitated, but at Crownsville, these were not opportunities for jobs. The hospital only stopped forced labor in the late 1960s. By then, lawmakers had grown accustomed to not funding Crownsville the way they funded pure White institutions, and Crownsville started to struggle. Neighbors worried about riots or escapes, and money went into carceral measures instead of more therapists and doctors. Over time, even as the place looked less like a slave plantation, it became intent on incarceration.
Kate Woodsome: It's not an easy history to hear, and I imagine it was just as hard to uncover. How did you begin this work?
Antonia Hylton: I come from a family with a history of mental illness. And I grew up hearing the stories of my great grandfather, who was sent to a segregated ward of an institution in Michigan. I grew up seeing my father struggle because his first cousin, mentor and good friend had been killed by a police officer in the midst of a mental health crisis on the steps of a federal building in the 1970s. And my father had lost one of his best friends and really had never been able to talk about it and process that.
Then while I was doing the work of this book, a loved one in my immediate family was diagnosed with schizophrenia. Trying desperately to find this person care in the midst of the pandemic, it was horrifying to see some of the parallels between our current moment and what I had uncovered in the records all the way back to 1911.
Kate Woodsome: What were some of the parallels?
Antonia Hylton: Back in 2020 and 2021, my loved one was having a delusional hallucination that they were being hunted by a group of White supremacists. At the time, people — certainly people in the Black community — were going through a lot of pain after the murder of George Floyd, all the way up to the events of January 6th [where White supremacists stormed the U.S. Capitol].
My loved one kept trying to find a psychiatrist in Massachusetts who would talk to them about race in America, who would help them process these fears, these nightmares, these visions that they were having. And they kept being told by doctors that race wasn’t really an issue. Their care team was all White. When my loved one tried to talk about what January 6th meant to them, their fear of extremist movements in the United States, and what that might mean as a Black person in this country, their doctors did not want to have that conversation. Those interactions set them back.
The kind of isolation my loved one was feeling was painful enough, but what this really meant was their recovery was shattered. Their trust in our medical system was shattered. It would take my family years to find a therapist they could trust. And I come from a family with good health insurance.
Kate Woodsome: In your book, you talk about how conditions at Crownsville gradually began to improve when Black people began to be employed as cleaners. What lessons can be applied today?
Antonia Hylton: When integration begins, the Black employees describe memories of this smell hitting them. They would see feces all over the floor, that no one was washing or combing the hair of patients. So, they were sitting patients down on the floor between their knees, and for the first time, combing out their curls and braiding up their hair. This was work they weren't being compensated for and weren't asked to do or supported in, but they realized they had to bring humanity into this place. Over time, the hospital staff becomes less and less white, and there’s this fascinating moment where it becomes almost a community institution.
These are health care workers who go to the same schools, churches, live in the same neighborhoods as their patients. They rode the bus to school with them. They know their moms. They're able to call home and reconnect them. So, there's this window from the late 60s to the early 80s, where this really becomes an all-Black institution. You start to see a glimpse of something that we had once been promised would happen around the country — community mental health care.
When Crownsville closed in 2004, many patients were living under bridges and overpasses in Baltimore and Annapolis, getting picked up by police and sent to jail and prisons. Former Crownsville workers started going out into the neighborhoods, checking in on their patients, doing what they could to help them. During the pandemic, some of them who are quite elderly were packing Covid masks and snacks and bananas and socks and warm clothes and driving to patients they hadn't been assigned to work with for almost 20 years.
I think what's missing from our mental health care system now is any sense of community. That connection, that love, that care. I hear every day from readers, from health care workers, who want to be that caring person but feel like everything about the system is making it impossible for them to do that. And we're not really providing people mental health care if that's not present.
Kate Woodsome: How can we support not only people with mental illness, but those who are caring for them?
Antonia Hylton: I spoke to so many healthcare workers who described feeling like to save their patients, they had to pick apart pieces of their own soul to fill someone else back up, to make them whole again. So I also think a key solution is to professionally support and pay these people what they deserve.
The other piece is that a lot of these systems are interconnected. Research shows that investing in public schools is good for mental health. Having spaces where kids feel safe to explore and make mistakes without being surveilled nourishes their mental health and resiliency. If you invest in those things, you're going to pay a lot less on the back end.
I spend a lot of time at NBC News covering book bans and the removal of certain history lessons from our schools, and I now see this in a different light. It’s less about just the First Amendment and people's right to read books. Research shows us that having access to community materials is a key part of people’s health and well-being. Kids, especially of color or LGBTQ kids, knowing their value, their history, why they matter, what's their context in this country, that is a protective factor, a supportive factor. When someone wants to take that from you, what are they doing? It's about our health, our survival.
If we rallied behind all these interconnected public goods and supports, showed up and used our libraries and parks and backed our public schools, that's a small way you're supporting the people who are working in the system.
Love is clearly the path forward. At a time when so many people are desperate for these services, there's really no excuse to not get up tomorrow and try to help the people who I know.
Kate Woodsome: What’s missing in this “self-care” moment?
Antonia Hylton: People are being encouraged to download meditation apps and do all these individualistic things to somehow solve our mental health crisis, and I'm not against those services or programs, but so long as this is perceived as a personal problem, then it's very hard to have a constituency.
I think after the pandemic, we realize we're all a part of that constituency. It's not us versus them, the healthy versus the unwell. All of us are very much involved and implicated in and personally touched by this. How do we translate that into a place, a public movement, a community that someone feels like they have to answer to us? That's the piece that's missing. The way this country is set up, the money doesn't come until people feel like they have to answer to you.
Hi, I’m Kate!
I’m a journalist and filmmaker formerly with The Washington Post, where I won the Pulitzer Prize for Public Service with colleagues covering the January 6 attack on the U.S. Capitol. I also pioneered a mental health column and managed a short documentary film unit. Deeply affected by the insurrection, I realized I was addicted to a job that made me sick. In 2024, I left The Post and founded Invisible Threads to embark on an ongoing exploration of the connections between the health of our minds and our body politic. With a mission to nourish individual and collective wellbeing through a more informed, compassionate public, Invisible Threads pursues its journalistic and educational goals through film, speaking, teaching and this Substack, which features new columns, expert interviews and resources on mental health and democracy every two weeks.
What bowled me over…
“A team of scientists has given the world its most intimate and dazzling view to date of the circuitry of the human brain, and the glimpse — published in the journal Science — is both shocking and awe-inspiring as an illustration of our ignorance.” — David Von Drehle in The Washington Post (Gift Link!)
What I’d invite you to explore…
The interview above. It’s pretty long, so I doubt it’s a one-click read. Bookmark it, come back to it. Share what you learned. You and me — we’re “the system” — so if you don’t like what you see, tell someone, then do something.
What I’d invite you to do…
Use your public libraries and parks, support public schools. Be kind to someone. Build community. Become the constituency politicians must answer to.