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The alienist’s bias
Sorting the mentally ill by race
In the summer of 2001, Martin Summers, an associate professor of history at Boston College, was starting exploratory research on relations between African Americans and federal government institutions. At the National Archives in Washington, D.C., he delved into a trove of 19th-century records from St. Elizabeths Hospital, founded in that city as the nation’s Government Hospital for the Insane in 1855.
The hospital, relates Summers, was set up to shelter and treat the mentally ill who came under federal jurisdiction, including members of the armed services, veterans, and D.C. residents. One of the first documents Summers examined was a register book, in which a clerk had recorded names and biographical details of patients admitted in 1866. There was a ledger column for diagnosis and a column for the supposed cause of the illness. One entry, for a black woman, was especially striking, Summers recalls. The cause of the woman’s distress (mania was the official diagnosis) was reported as “the blackness of her husband.”
“That really arrested me,” Summers says. “What does that mean? I still don’t know that I know the answer to that, but I thought at that point, this was a study I wanted to do—I wanted to focus on perceptions of insanity and race.”
Summers details some of his findings in an article published in the spring 2010 Bulletin of the History of Medicine. Using St. Elizabeths as his central case study, he traces the ways medical and psychiatric authorities assumed African Americans were psychologically different from whites, from the mid-19th to the mid-20th century.
In the 19th century, physicians, naturalists, and ethnologists were in the thrall of Creation’s differences—ever ready to classify and rank—and many were particularly eager to “empirically and quantifiably certify the distinction between the ‘Caucasian’ and ‘Negro’ races,” which they assumed existed, says Summers. Charles H. Nichols, St. Elizabeths’ first superintendent, advocated for segregated quarters. “Like most of his fellow superintendents,” Summers writes, “Nichols believed that blacks and whites were fundamentally so different that proximity between the two would hinder . . . their treatment.” Racial differences seemingly were held by the staff at St. Elizabeths to be more significant even than gender differences, notes Summers; the so-called lodge that early on housed the hospital’s “colored insane,” while all black, housed both men and women.
And just how were blacks believed to be psychologically different? It was conventional wisdom in the mid- to late-1800s that insanity was relatively rare among peoples unburdened by Western civilization. An article in the American Journal of Insanity in 1845, for instance, discussed the “exemption of the Cherokee Indians and Africans from insanity.” In this view, mental instability arose with exposure to the stresses of modern life; for individuals new to these stresses, the effect could be dramatic.
Indeed, some psychiatrists made claims that mania was the more common affliction among blacks, while unstable whites were more likely to slip into melancholia. “The insane negro is combative and homicidal,” wrote one medical observer in 1886, “but suicidal tendencies rarely exist.” At St. Elizabeths, this belief led eventually to a pattern of putting most black men, regardless of their diagnosis, in quarters for the criminally insane. After construction of a new building in 1887 for convicts and insane inmates judged to be dangerous, it became standard practice to house all black men with the prisoners.
The 1930s saw the emergence of a “universalist school” in psychiatry, which rejected the idea of race-based distinctions. According to Summers, the old idea of black insanity brought on by a civilized world gradually gave way to a focus on the personality damage resulting among blacks from the effects of racism.
The St. Elizabeths archives include correspondence from patients and family members, along with medical records. Summers has been mining these materials for a book of social history that will portray black patients’ conditions, examine the shifting psychological theories of the day, and recount the ways those ideas affected the hospital’s administration. “My aim is to provide a comprehensive portrait of these patients’ lives,” he says.
Read more by Dave Denison