The mind and sanity of the negro was a topic among white doctors across the South both prior to and following emancipation. Many of their theories sought to justify Black folks’ inferiority and the necessity for slavery. That history is interwoven with the story of Crownsville, Maryland’s first psychiatric hospital to house Black people. In her new book, “Madness: Race and Insanity in a Jim Crow Asylum,” Antonia Hylton holds a mirror up to our current mental health care system through her detailed history of Crownsville and the patients who lived and often died there. Through oral histories, newspaper articles, photos and other archival documents, Hylton elevates the untold stories of patients, their relatives and former employees.

Black Joy had the privilege of chatting with Hylton about her personal connection to her research, the present-day implications of Crownsville’s history and what she hopes the long-term impacts of sharing this story will be.

What was your experience writing this book and documenting such heartbreaking stories while also having a personal connection to the subject matter?

Writing this book was both the most rewarding and wonderful experience of my life. It introduced me to an amazing community in Maryland. I have gained all these relationships with elders, particularly in that community who have almost taken me in as their grandchild or their niece. And I have felt so much new love in my life because of this story, but also because of the nature of what I’ve discovered in my research or the stories that I was told by the people that I met along the way, it at times really broke me down to cover this. And I think most Black people in America at this point, they live with an understanding of our history and they know the way in which slavery and people’s beliefs about our place in this country has shaped our medical experiences too.

As I was reporting this story, a family member of mine was going through a mental health crisis and my family was desperately trying to connect this person to care . . . we have health insurance, and even with that, it was both extremely expensive, extremely difficult. And when my loved one did get connected to care [and] going to certain facilities, they were all white. They would call us and tell us that they felt like doctors weren’t really listening to them, that they rolled their eyes at them, that they didn’t believe them. And this was especially concerning to us because the delusions that they were having as a result of the illness were specific to the Black experience . . . fears that they were being hunted by a group of white supremacists. And so, in my family’s view, they needed someone who cared about that history, who understood why a Black person living in this country might have those fears.

And so, to see that that’s what our modern mental health care system looks like while also researching how much things haven’t changed, right? When you’re looking at a story of an asylum that was founded in 1911, and you’re reading the testimony and the stories of patients who felt like their voices went unheard at that time. And then I’m living this with my loved one, it crushed me a lot. I loved writing this book and I’m so deeply proud of “Madness,” but in many ways I’ve been forever changed by the experience and parts of the reporting process brought me to a low place while I was going through it. There’s no regret there, to be clear, but I think there’s no way to do this kind of work and to get to the bottom of what happened in the system without letting it break you down a little bit.

I was nearly brought to tears reading some of the stories. I actually had to pause for a few days while reading it. As the writer, how did you take care of yourself while having to process all these different things alongside your own experience?

So, I joined a Black-owned boxing gym in New York City . . . I wanted to be around people who I could vent to and they’d get it and I wanted to just hit something hard and then feel like I had a release, a space to process my anger at the world. And so that’s probably thing number one. Two is, I am one of seven kids and I really involved my family in my reporting process, which is something a little bit unusual. . . But in this case, because of the nature of the connection, I involved my family really closely. . . When I was down, I would visit some of my older sisters. I had weekly Zooms [with my siblings} during the pandemic when we couldn’t physically visit each other while I was writing the book and I would talk to them and we would cry together on Zoom. Sometimes we would also strategize about what we were all gonna do to support our loved one who was having a hard time and without them, I would not have gotten through all of this.

And then I also really learned how to stick up for myself. So, I have my busy job at NBC and working in news can be incredibly demanding and you can lose your weekends, you can work really late nights, many days in a row. And a younger me said yes, all the time and let myself kind of get to the end of my rope and get stressed out. But I learned to set some more boundaries. I learned that I could work hard, but also demand some time off. I learned that I could give my everything to the stories that I cared about as a reporter, but also really cherish my vacation days and my weekends and I made a lot of new time for myself. And I’ve been very careful about protecting it. And then the final piece is that I have a therapist and I’ve worked with a therapist for years and I’m very proud of that.

There is a lot of mental health stigma in the Black community. But aside from that, there are a lot of barriers we face with getting access to mental health support, especially culturally competent support. How do you think the history of Crownsville connects to present day ideas about mental illness in the Black community?

Well, the first thing for me is that learning the history of Crownsville actually gave me a more compassionate and patient view of some of my elders who were very anti-therapy [and] anti-psychiatry when I was younger. And I wanted to talk about these issues or talk about mental health with some of my older relatives and they would reject the conversation or say that they didn’t believe in that stuff. I would get angry at them. I would think that they were old school and out of touch and I would kind of roll my eyes at them with my siblings. I think a lot of young Black kids probably have been through something similar, but once I understood more of what mental health care actually looked like for Black people for most of the 20th century, I started to realize, ‘Oh, you know, they maybe knew something I didn’t know at the time’ and perhaps they tried to access some of these systems and they know people who tried and who were harmed or even lost to these systems.

When you look at the history of the hospital and you realize, I’m giving you a story of one of these hospitals, but there were other hospitals just like it all over the United States. And there are these patterns of patients who are left to fend for themselves, not given proper food, not given beds, not given real treatment. At times they are for decades, essentially wasting away, that people have allowed them to almost be disappeared and disconnected from their communities. I think there’s no way to learn that and to see that and to not see the connections then to a current reality in which so many Black people still feel like they are marginalized by these systems, like they are out of reach or that if they enter them, they’ll be unsafe because for most of our country’s history, that was the truth.

It puts a lot of pressure right on the current medical establishment to think about, what history do I need to know? What actions do I need to take to support patients from all different backgrounds to make up for the fact that whether you like it or not, this history is real, and it has this long-lasting generational impact. So, it’s very hard to talk about building a better future and imagining a better system if you don’t actually understand why your system operates the way it does right now. And so, I think that’s part of the motivation for me of studying Crownsville is, go back to go forward. And you won’t be able to treat these patients properly, to give them the dignity and care that they deserve in the current day and age if you don’t look at what was done to them and their loved ones and their parents and their grandparents for decades already.

When speaking with families and other folks previously affiliated with Crownsville, was there ever joy present even as they were recounting the stories?

Absolutely. The book is full of heroes, of people who showed up day in and day out at this place to serve people who look like them and to try to give them support. And for me, all of those people, they uplifted me and I think they will uplift readers who experience Madness and to give some context, Crownsville starts out as this Jim Crow Asylum in which there are all Black patients and only white employees. But in the mid 20th century, they finally desegregate the hospital and allow Black employees to start working as aides, as nurses, as doctors and as more and more of them arrive, the better the outcomes at the hospital become. And we start to hear stories of Black nurses going above and beyond, [bringing] clothes and shoes and belts in for patients who have been neglected and not given proper things to wear, inviting patients to their own homes to give them a sense of family and another space away from the hospital. And so, they try to bring all of this compassion into their work.

And there’s this pattern of many of these employees describing to me that they hear from the patients that for the very first time after their arrival, they feel they’re seen, that they’re being treated by people who know them, who look like them and who in some cases even went to school with them or went to church with them and grew up with them. Think about that for a minute because that is not what our mental health care system looks like now. If you go to your local emergency room in the midst of a mental health care crisis, you are not going to see a high school classmate who loves you and who wants to take care of you and who’s going to be with you every step of the way, but that’s what was happening in Crownsville. And so there’s a little bit of a duality there, there’s this horrible history, this segregation and racial injustice, but then there’s this moment of opportunity where a Black community is able to serve itself and take care of its own.

What do you hope are the long-term impacts of providing this history of Crownsville and elevating these voices that hadn’t previously been elevated and whose stories had gotten lost?

My greatest hope is that the story of Crownsville helps people all over this country, not just in Maryland, not just in Black communities, imagine something better for us all. And as much as this is a Black community story, it’s their voices, their oral history. It’s really an American story with implications that affect all of us. If we let our mental health care system fall apart, that doesn’t just impact poor Black Americans, that impacts everyone. And I hope that people see themselves in this story, that it helps them understand why our country has worked the way that it does and that in their different communities, whether that’s on the local level, the state level, the national level they ask for what they deserve. I also really hope that there are other families out there that need this book to start a conversation. I can share that there are family members of mine who are now open to therapy, who have sought certain help after learning all of this. And if it has a similar impact for just a couple other people, I will feel really good.