Madness in the City of Magnificent Intentions
A History of Race and Mental Illness in the Nation’s Capital
MARTIN SUMMERS
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For Karl
CONTENTS
Acknowledgments ix
Introduction 1
1. “Humanity Requires All the Relief Which Can Be Afforded”: The Birth of the Federal Asylum 13
2. The Paradox of Enlightened Care: Saint Elizabeths in the Era of Moral Treatment, 1855–1877 39
3. “From Slave to Citizen”: Race, Insanity, and Institutionalization in Post-Reconstruction Washington, DC, 1877–1900 71
4. Care and the Color Line: Race, Rights, and the Therapeutic Experience, 1877–1900 95
5. “Mechanisms of the Negro Mind”: Race and Dynamic Psychiatry at Saint Elizabeths, 1903–1937 125
6. “He Is Psychotic and Always Will Be”: Racial Ambivalence and the Limits of Therapeutic Optimism, 1903–1937 153
7. Mental Hygiene and the Limits of Reform: Saint Elizabeths in the Community, 1903–1937 190
8. “An Example for the Rest of the Nation”: Challenging Racial Injustice at Saint Elizabeths, 1910–1955 217
9. Whither the Negro Psyche: Integration and Its Aftermath, 1945–1970 247
10. From Model to Emblem: Community Mental Health and Deinstitutionalization, 1963–1987 277
Conclusion 309
Notes 315
Selected Bibliography 369
Index 377
ACKNOWLEDGMENTS
This is not the book that I set out to write. Trained as a cultural historian of the nineteenth- and twentieth-century United States, with particular interests in race, gender, and sexuality, I intended to write a book about black masculinity, institutions, and the state when I began my research in 2001. A chance encounter in the National Archives with a dusty, brittle admissions book of a federal insane asylum that summer set me on the path to writing this history of race and mental illness in the nation’s capital. Over these past eighteen years, I have learned a great deal about the field of medical history and even more about myself as a historian. Along the way, I have accumulated many debts which I am grateful that I now have the opportunity to acknowledge.
My largest intellectual debt is owed to scholars who showed a great deal of enthusiasm, encouragement, and support for my project in its earliest stages. As someone who was excited yet tentative about entering a field in which I had no graduate training, my initial trepidation was alleviated by the early positive responses from James Mohr, Ellen Herman, and Laura Briggs. Jim and Ellen, my colleagues at the University of Oregon, were some of my most ardent champions and wisest counsels. I thank them for the years of advice and friendship that they have given me, as well as for all of the letters they have written on my behalf. Laura was a commenter on a paper that I gave early in the research process, and her engagement with the work and thoughtful remarks helped shape the scope of the project and the kinds of questions that I ended up pursuing. She has remained a steadfast source of support over the past dozen years, and I am deeply appreciative.
My growth as a scholar has been made possible by the relationships that I have developed and the conversations that I have had over the past several years with other scholars who are doing important work on the history of race and medicine. I thank Dennis Doyle, Sharla Fett, Susan Reverby, Samuel Roberts, and Keith Wailoo for the interest they have shown in my work, for their camaraderie,
and for modeling the kind of scholarship that I aspire to produce. I am also grateful to Laurie Green and John Mckiernan-González, my former colleagues at the University of Texas at Austin and collaborators, for the many hours-long discussions that we have had over kitchen tables, in hotel lobbies, and on the phone over the past several years. Even though working on our coedited collection delayed progress on this monograph, it was a rewarding experience and greatly contributed to my maturation as a scholar. I thank them for their constant companionship on this journey.
Writing a 132-year history of a single institution and its relationship to the surrounding community has required a great deal of archival, research, and financial assistance. I want to thank the staffs at the American Antiquarian Society, DC Public Library (Washingtoniana Division), George Washington University’s Special Collections Research Center, Harvard University’s Houghton Library, Institute of Pennsylvania Hospital Archives, Library of Congress, National Archives, National Archives II, National Library of Medicine, and Saint Elizabeths Hospital Archives. I especially want to thank Saint Elizabeths’ former librarian, Velora Jernigan-Pedrick, for her indispensable assistance in working through an un-inventoried collection. Matthew Gambino, who was working on a dissertation on Saint Elizabeths, graciously put me in contact with Ms. JerniganPedrick, and I am grateful to him for it. Clinical staff members and historical enthusiasts Suryabala Kanhouwa and Jogues R. Prandoni generously shared their knowledge about Saint Elizabeths and their published research with me. The enthusiastic reception and support of Patrick Canavan, Saint Elizabeths’ CEO in the mid-2000s, for my project was particularly welcome, as was the advice and offers of assistance by Marc Shaw, the lead architect of Saint Elizabeths’ new state-of-the-art hospital.
This monograph could not have been completed without the timely and professional assistance of the interdisciplinary services staffs at the University of Oregon, the University of Texas at Austin, and Boston College. I am also particularly indebted to the library staff at the National Humanities Center— Jean Houston, Eliza Roberts, Brooke Andrade, and Sarah Harris—who ran an incredibly well-oiled machine and tracked down obscure material with alacrity and good cheer. I wish to thank Holly Reed and Kaitlyn Crain Enriquez of the National Archives Still Pictures Division for their last-minute assistance in obtaining images for the book. I have also benefited from the excellent and meticulous research skills of graduate students and undergraduate students alike, including Elizabeth Medford, Juandrea Bates, Wangui Muigai, Adam Rathge, Andrew Schneider, and Emily Sloan.
Financial support from a number of universities, research centers, and foundations was indispensable. New Faculty and Summer Research Awards from the University of Oregon in 2001 and 2003, respectively, funded the very
Acknowledgments xi early stages of this project, as did research monies associated with the university’s Underrepresented Minority Recruitment Program. A Dean’s Fellowship from UT-Austin in 2006 provided further research support. An American Council of Learned Societies Frederick Burkhardt Fellowship allowed me to spend a year at the Radcliffe Institute for Advanced Study. In addition to the ACLS, I would like to extend my gratitude to Barbara Grosz, then dean of Radcliffe; Judith Vichniac, director of the fellowship program; and the Radcliffe staff, especially Melissa Synott. I want to thank the Office of the Provost of Boston College for a sabbatical fellowship in the spring of 2011 that enabled me to begin writing. The provost also provided supplemental funding for a National Humanities Center fellowship in 2013–14. I would like to acknowledge the wonderful leadership and staff of the NHC—Geoffrey Harpham, Elizabeth “Cassie” Mansfield, and Lois Whittington in particular—as well as the generous support of Ruth W. and A. Morris Williams Jr. I would not have been able to complete this book without them. Karen Carroll’s editorial assistance while I was an NHC fellow improved the manuscript’s clarity and sharpness. Finally, I want to thank all of those people who have kindly given their time to write letters of recommendations over the years—for more unsuccessful fellowship proposals than I care to admit. In addition to Jim Mohr and Ellen Herman, these generous folks include Laura Briggs, King Davis, Glenda Gilmore, and Robert Self.
I have profited enormously from the support and friendship of amazing colleagues at a number of institutions. At the University of Oregon, Ellen Herman, Shari Huhndorf, Jeff Ostler, and the late Peggy Pascoe were ideal senior colleagues and invaluable friends. Jafari Allen, Tiffany Gill, Frank Guridy, Jim Sidbury, and James Wilson made UT-Austin a welcoming place and an invigorating, if all too brief, intellectual sojourn. I have benefited from the leadership in the Department of History at Boston College, including past and present chairs Lynn Johnson, Jim Cronin, Robin Fleming, Kevin Kenny, and Sarah Ross. I have also enjoyed a collegial environment and especially the friendship of Robin Fleming, Kevin Kenny, Lynn Johnson, Priya Lal, Patrick Maney, Karen Miller, Arissa Oh, Prasannan Parthasarathi, Sarah Ross, Dana Sajdi, Franziska Seraphim, and Deborah Levenson, my stalwart and star-crossed Spanish tutor. I am indebted to my current and former colleagues in the African and African Diaspora Studies Program, especially Richard Paul, Régine Jean-Charles, Cynthia Young, and Rhonda Frederick for their friendship and support.
In the course of writing this book, I have had the good fortune of receiving excellent and challenging feedback from friends, colleagues, and strangers. The following folks have contributed to the final shape of this book either through reading drafts of chapters or the entire manuscript or just through questions and comments delivered in informal or formal conversations: Heidi Ardizzone, Elizabeth Alexander, Elizabeth Armstrong, Nancy Bercaw, Susanna Blumenthal,
Acknowledgments
Julian Bourg, Joel Braslow, Lundy Braun, Erika Bsumek, Simone Caron, Sylvia Chong, Nancy Cott, Dennis Doyle, Matthew Gambino, Tiffany Gill, Janet Golden, Jennifer Gunn, Mark Hauser, Rana Hogarth, Lynn Johnson, Stephen Kenny, Elizabeth Krause, Regina Kunzel, Toni Lester, Deborah Levenson, David Levering Lewis, Jacqueline Malone, Michelle Moran, Rebecca Nedostup, Deirdre Cooper Owens, Anne Parsons, Naomi Rogers, Tim Rood, Jonathan Sadowsky, Dana Sajdi, Londa Schiebinger, Robert Self, Suman Seth, Karen Sotiropoulos, Melissa Stein, Melissa Stuckey, Megan Sweeney, Emma Teng, and Rhonda Y. Williams. The process of writing this book was also enormously enriched by the many discussions that I had with a phenomenal array of scholars at the National Humanities Center—in hallways, over glasses of wine during happy hour, and over delectable meals, especially Tuesdays’ grits! For their intellectual camaraderie, I would particularly like to acknowledge the members of the History, Race, and the State Seminar, especially Julie Greene, Luis CárcamoHuechante, Sylvia Chong, Tim Marr, Elizabeth Krause, Martha Jones, Evelyn Brooks Higginbotham, and Marixa Lasso; and members of the Knowledge and Context Seminar, especially Andy Jewett, Lynn Festa, Chad Heap, and Charlie McGovern. Various versions of chapters were presented at a number of conferences and public lectures. For their generous engagement with my work, I would especially like to thank the organizers of and audiences at the University of Notre Dame’s Henkels Lecture in April 2007; the University of Mississippi’s Porter L. Fortune, Jr. Symposium in March 2012; the University of Oregon’s Peggy Pascoe Memorial Lecture Series in November 2013; the University of Minnesota’s Dorothy Bernstein Lecture in the History of Psychiatry in September 2014; and the History Department at Brown University in March 2016. The anonymous readers for Oxford University Press also provided invaluable feedback, and I thank them for it.
At Oxford University Press, I have benefited from Nancy Toff’s support, editorial diligence, and low tolerance for language that obfuscates rather than clarifies. I also want to thank Nancy’s assistant, Elizabeth Vaziri; Marie Felina, the book’s project manager; and Judith Hoover, the copy editor.
It gives me extraordinary pleasure to be able to acknowledge my friends and family, whose steadfast support means the world to me. Unfortunately, two of my friends and mentors did not live long enough to see this book’s publication. Peggy Pascoe and Clement Alexander Price taught me a great deal about being a good historian, a good teacher, and a good soul. I’m still trying to live up to the standard they set.
I have had the good fortune of having Franklin Parrish in my life for more than half of it. We both keep getting better with age, I like to think. I met Erika Bsumek in my first year of graduate school, and she has been a dear friend ever since. I thank her for all of the encouragement and support she has given me over
the years and for all of the wonderful times and life events that we have been able to share. I also want to thank the Fujiwara-Morozumi clan, our West Coast family. Lynn, Steve, Kyra, Joanna, and Martin have enriched my life in more ways than I can count, and I am so grateful to them for it.
I thank my father, Charles Summers, and my brother, Scott Summers, for modeling for me what it is to live a life of integrity and purpose. Although I did not end up working with the same kind of student population, my late mother Loretta Summers’ passion for teaching, along with the way that she led her life, continues to inspire me. I also thank my father’s partner, Kay Henry; my sisterin-law, Wendy Summers; my niece and nephew, Lauren and Christian Summers; my aunt, Barbara Mead; my godsister Nikitea Vaughn; and my godson, Liam Hannon, for their love and support. And words cannot express how much I love and miss my sister, Carla Summers, who taught me so much about life, music, and food. I think about her every day.
And, finally, I am so happy to be able to acknowledge Karl Mundt. He has had to endure more closed study doors over the past decade than a husband should have to, and he has never once complained. His love and support as a partner and a friend are beyond measure. Whenever an academic asks me if my husband is an academic as well, his or her eyes light up when I respond, “No, he is a choreographer and a dance teacher.” I don’t know what that says about our respective career choices. But I do know that I could not have made a better choice for a life partner.
Introduction
For most of its history, Saint Elizabeths Hospital was considered by nearly everyone who had a relationship to it to be an exceptional institution. Founded in 1855 in Washington, DC, the insane asylum was envisioned by Congress and Presidents Millard Fillmore and Franklin Pierce as providing “the most humane care and enlightened curative treatment” to the soldiers and sailors of the nation as well as the residents of the nation’s capital. While considering an offer to become its first superintendent, Dr. Charles H. Nichols expressed the desire to his friend, the reformer Dorothea Lynde Dix, that he be given the resources and latitude to build a “model hospital.” Dr. William Alanson White, who directed the hospital for nearly the first four decades of the twentieth century, often spoke of the institution’s unique position as a research and teaching hospital. Its location in the nation’s capital, its funding from the federal government, its proximity to elite medical schools, and its special patient population made White’s assessment of Saint Elizabeths’ singularity one that was shared by his colleagues in the psychiatric profession. Even as the paradigm of mental health care was transitioning from the large public hospital to the decentralized community center model in the post–World War II era, government and hospital officials hoped that Saint Elizabeths would “provide an example for the Nation” in how to make the transformation seamlessly.1
Saint Elizabeths’ exceptionalism—both presumed and real—was due in no small part to its status as a federal institution in a federal district. For roughly a century, during which the care of the mentally ill fell primarily to state and local governments, Saint Elizabeths was one of the few mental hospitals that was largely funded by Congress and that served patients who were considered wards of the federal government.2 In some ways, when Nichols aspired to make Saint Elizabeths a model hospital, he was expressing his belief that he and his staff could make it the pacesetter for the rest of the nation’s asylums. But he and those who followed him as superintendent also maintained a certain investment in the notion that Saint Elizabeths’ exceptionalism exceeded national borders. As it was, effectively, the national asylum, Saint Elizabeths carried the burden
of representing the virtues of the American medical profession’s approach to treating mental illness. Those associated with the hospital often interpreted this burden not as an unwanted responsibility but as an opportunity to demonstrate the American capacity to keep pace with the advances in the treatment of mental illness made by the British, French, and German medical professions and to trumpet the values that were specific to American culture and society. As Nichols’s successor, Dr. William Whitney Godding, expressed in 1878, shortly after assuming leadership of the hospital, Saint Elizabeths “should be in a position to show to other nations the liberal provision that America makes for her defenders when they become insane.”3
In the very early days of its operation, the hospital’s Board of Visitors articulated this particular strain of exceptionalism when it reported on the construction of a lodge for African American patients. “The erection and occupancy of a lodge for colored insane,” the board boasted, “possessing most of the provisions of an independent hospital, inaugurates, we believe, the first and only special provision for the suitable care of the African when afflicted with insanity, which has yet been made in any part of the world, and is particularly becoming to the Government of a country embracing a larger population of blacks than can be found in any other civilized state.”4 While the board pointed to the lodge as a testament to the liberal humanitarianism, scientific and medical advancement, and racial magnanimity of the United States, the segregation of black and white patients was befitting an institution located in a city in which the slave trade had been banned only six years earlier and in which slavery would be legal for another six years.
The coexistence of these seemingly contradictory features of Washington, DC—the rhetoric of freedom and equality and the reality of slavery and racism—was reflected in the label Charles Dickens gave the capital after his visit in the early 1840s. The “City of Magnificent Intentions” referred directly to the grandness of the capital’s design and architecture and the relative emptiness of the city itself. But when he wrote of slave traders in Washington as “hunters engaged in the Pursuit of Happiness,” Dickens was also critiquing the emptiness of the grand ideals of American democracy.5
The need to construct separate facilities for a racial group that, despite occupying an ambiguous position in the psychiatric imagination, would constitute a significant portion of its patient population was further indicative of the exceptionalism of Saint Elizabeths. From its very beginning, in fact, Saint Elizabeths admitted African American patients. Some were soldiers and sailors, but the majority of African Americans committed were civilian residents of the District of Columbia who were medically diagnosed as insane and legally determined to be too poor to afford private care. Although they did not always come close to matching their percentage of the total population of the District, the
substantial numbers of African Americans in Saint Elizabeths made it one of the few insane asylums in the United States with a significant racially heterogeneous patient population before the mid-twentieth century. As such, the hospital is an ideal site in which to examine the coexistence of racialist thought and scientific objectivity, medical altruism and racist treatment, and institutional power and individual agency.
This book is a history of the relationship between Washington, DC’s African American community and Saint Elizabeths Hospital from its founding in 1855 to the deinstitutionalization of the District’s mentally ill population in the 1970s and 1980s. It is at once a cultural history of medicine that acknowledges the real materiality of disease while also taking into account the socially constructed nature of illness; an institutional history that situates both the admirable and the less than noble efforts of medical professionals within an ever evolving field of psychiatric knowledge and the more mundane arenas of bureaucracy and politics; and a social history of African American patients and the communities that cared for, loved, feared, and abandoned them.6 In weaving these various strands together, the book reveals the connections among ideas of racial difference, moral and medical understandings of mental disease, the institutional disciplining of “deviant” bodies, the myriad ways in which those who were diagnosed as insane bore their illness, and their own attempts as well as those of their families and friends to manage their therapeutic experience.
Racializing Disease, Racializing the Sufferer
Race—as both ideology and lived experience—figured prominently in how hospital officials understood the mission of the institution and subsequently designed and operated it, in how hospital officials conceptualized categories of mental disease and consequently developed therapeutic regimes to address them, and in how patients experienced their confinement in Saint Elizabeths. Ideas of racial difference functioned in the hospital’s clinical settings and wards in more complex ways than the segregation of patients that was customary in medical institutions prior to the mid-twentieth century, or the racial animosity that some white doctors, nurses, and attendants, immersed in a racist culture, would have inevitably exhibited toward their black patients. Ideas of racial difference were foundational to the production and deployment of psychiatric knowledge from the mid-nineteenth to the mid-twentieth century. Indeed, what a history of Saint Elizabeths reveals is the ways in which the American psychiatric profession engaged in an (often) unarticulated project that conceptualized the white psyche as the norm. This not only meant that the white sufferer of
mental illness occupied center stage in the psychiatric profession’s consciousness, even though this was rarely explicitly expressed. It also meant that the psychiatric profession’s routine manufacturing of racial difference constructed the black psyche as alien and fundamentally abnormal. This belief in distinctive racial psyches contributed to the persistent marginalization of mentally ill African Americans over the course of the development and evolution of American psychiatry, from the era of moral treatment in the mid-nineteenth century to the rise of neurology in the late nineteenth and the hegemony of dynamic psychiatry in the mid-twentieth.
A history of Saint Elizabeths and its relationship to the District’s African American community encourages a fundamental reassessment of how race and racism operated in the asylum and larger psychiatric profession. The historiography of mental illness and mental institutions in the United States is several decades old and has produced numerous interpretive schools: from asylums as manifestations of benevolent reform to asylums as mechanisms of social control.7 As robust as this historiographic tradition has been, however, few scholars have situated race at the center of their examinations of the asylum. Until recently, few of the works that have dealt with the presence of African Americans in mental institutions have used race as a category of analysis, instead merely documenting the discriminatory treatment to which they were subjected. In other words, they largely assumed that race relations within the asylum simply mirrored the relationships between blacks and whites that existed in the larger culture.8 While this was certainly the case in many respects, more recent work has begun to explore the manner in which ideas of racial difference were embedded in the very ways that psychiatrists thought about mental health and mental illness and how they subsequently treated and managed patients.9 The important challenge of current historical scholarship on mental illness and psychiatry in the United States is to unearth the complex, subtle, and explicit ways that psychiatrists and experts in cognate fields produced and reproduced the “truth” of racial difference as they incorporated these preconceptions into their approaches to insane whites and people of color.10
Psychiatrists’ positing of the reality of distinctive racial psyches and their prioritizing the white sufferer of mental illness began before Saint Elizabeths opened its doors in 1855 and continued to shape much of the institution’s ethos. In situating the hospital in a part of the District considered to be a healthy environment for whites, and by justifying the racial segregation of patients on the principle of therapeutic efficacy, for instance, Superintendent Nichols placed the restoration of reason and the preservation of sanity for white Americans at the center of his medical mission. Some six decades later, with the enthusiastic support of Superintendent White, many of Saint Elizabeths’ psychiatrists, capitalizing on their access to large numbers of African American patients,
undertook clinical research aimed at developing comparative profiles of the black and white psyche. In doing so, they theorized the existence of a normatively primitive black psyche, which, similar to the psyche of a child, might serve as a window into understanding the abnormal psychology of the white sufferer of mental illness.
The presumption of a primitive, or child-like, black psyche, moreover, inhibited the development of intensive psychotherapeutic engagements between white psychiatrists and African American patients. At a point in the early twentieth century when mental illness was beginning to be understood as a product of an individual’s maladjustment to his or her environment, the dynamic psychiatric approach of plumbing the depths of a person’s unconscious through psychotherapy was rarely applied to African Americans. Indeed, the extent to which psychotherapy was used on African American patients at Saint Elizabeths prior to World War II was shaped, in the main, by the acute need to address the surface manifestations of their psychoses and a desire to transform them into tractable laborers. Although there were certainly some black patients who underwent the kind of intensive psychotherapy aimed at unearthing the complexes that underlay their mental illness, they were hardly the typical patients to receive this particular type of intervention. Saint Elizabeths’ psychiatrists were doing more than just privileging white sufferers of mental illness, however; they were also constructing a paradigmatic black madness that aligned with both the profession’s prevailing knowledge about mental illness and their own assumptions about the racial character of people of African descent. As the history of Saint Elizabeths illustrates, psychiatrists’ struggle with the existence of a group of people considered to possess a distinctive and inferior psyche led to a great deal of ambiguity, ambivalence, and antipathy when it came to treating mentally ill African Americans.
The ambiguous nature of the mad Negro had its very origins in the early nineteenth century, when physicians began characterizing insanity as a disease that was associated with the advent of modernity. Rapid economic development, educational advancement, and democratization, particularly, created an environment in which individuals were constantly exposed to phenomena that might result in physical and mental enervation, emotional stress, or heightened passions. The counterpart to civilization-induced insanity was the presumed mental health of those races situated lower on the evolutionary scale or those people who were caught in cultural stasis, including Africans and people of African descent, Native Americans, and indigenous peoples in Australia, New Zealand, and the South Pacific. Physicians based their explanations of so-called primitive people’s alleged immunity to mental illness on both biological and cultural postulates, indicating the intimate relationship between body and mind in nineteenth-century medical thought.
The constitutional imperviousness to insanity was attributed to both cerebral underdevelopment and the physical robustness of the primitive body. Culture also factored in in important ways. The fact that primitive peoples led relatively stress-free agrarian lives, physicians believed, accounted for the low prevalence of insanity among them. In the case of African Americans, the paternalism that characterized the slave-master relationship served to blunt the forces that might trigger mental illness in most individuals. The stern hand of the master prevented enslaved people from engaging in the kinds of vice that constituted both predisposing and precipitating causes of insanity, such as intemperance and “reading vile books.” Additionally, the benevolent care with which slaveholders treated their bondspeople, this logic went, removed from their lives those sources of emotional stress—“fear of poverty,” “disappointment in ambition,” “excitement in politics,” and so forth—that might serve as the catalyst of mental derangement.11 In effect, the salubrious nature of slavery’s labordiscipline regime bolstered the innate biological protection from mental disease that African Americans possessed. Despite this medical consensus, however, Saint Elizabeths counted African Americans among the very first patients who crossed its threshold in 1855.
The indeterminate relationship between biology and culture continued to shape psychiatric thought about black insanity in the late nineteenth and early twentieth centuries. By the 1880s, a new medical consensus—one that was subscribed to by William Godding, who directed Saint Elizabeths from 1877 to 1899—emerged. It explained an apparent rise in the number of African Americans being institutionalized by attributing it to emancipation. Ill-equipped either biologically or culturally to withstand the pressures of living in a modern civilization as free people, African Americans were purportedly succumbing to diseases against which they had held immunity during slavery, including tuberculosis, syphilis, and insanity. On the one hand, the failure of their nervous systems to evolve, combined with their unnaturally overdeveloped sexual organs, made African Americans more susceptible to madness, sexual or otherwise. The location of the etiology of black madness in the Negro’s biology fit well with an ethnological paradigm of race, the ascendancy of hereditarianism, and the development of neurology, a field of medicine that was based largely on a somatic understanding of insanity. On the other hand, the increasing propensity to become insane could be attributed to the lack of cultural development or the evolutionary proximity between African Americans and Africans. In either sense, emancipation had precipitated a degeneration of sorts, and the epidemic of somatic and mental diseases augured the race’s extinction.12
This postemancipation narrative of the atavistic Negro—the newly freed slave who was incapable of adjusting to his new status as citizen and was rapidly devolving back to his ancestral savage past—contributed to the patient
management strategies at Saint Elizabeths. Prone to diagnose mentally ill African Americans as being afflicted with mania and to characterize them more often than whites as dangerous and vicious, from the late nineteenth century to the 1930s hospital officials could make an easy decision to house African American male patients, regardless of their specific disorder or their civil status, in the same complex as insane prisoners and the criminally insane. And yet Saint Elizabeths staff members were just as likely to traffic in old, threadbare portraits of the docile, good-natured Negro whose institutionalization may have been more attributable to the race’s normal mental underdevelopment than an actual disease entity such as acute mania or chronic dementia. These ambiguous characterizations of African Americans were further complicated by the disconcerting acknowledgment by Saint Elizabeths’ psychiatrists that what they had been prepared to diagnose as mental illness in their white patients may have in fact been a manifestation of the Negro’s natural psychological makeup.13
The reduction of black madness to a state of mind that was not only antithetical to mental health but also different from white madness persisted well into the twentieth century. Paradoxically, the tendency to think about insane African Americans as flattened caricatures that were informed by larger racist cultural discourses contradicted dynamic psychiatry’s emphasis on the individual nature of mental illness. Rather than equating the natural histories of mental disorders with those of somatic diseases, which were considered to have generalizable symptoms and predictable outcomes, dynamic psychiatrists—whether they subscribed to Freudian psychoanalysis, Carl Jung’s analytical psychology, or Adolf Meyer’s psychobiology—advocated for the necessity of exploring the entire “life history” of the mentally ill person, a history that was rooted in and shaped by specific relationships and unique experiences.14 There was certainly room for considering the role of corporate identity in the etiology of mental illness, evident in Sigmund Freud’s concept of phylogenetic prehistory and Jung’s theory of the collective unconscious. Acknowledging the influence of the accretion of ancestral worldviews, cultural practices, and experiences allowed Saint Elizabeths’ psychiatrists in the early twentieth century to develop a comprehensive understanding of an individual’s mental disease, on the one hand, while holding onto the belief in the inherent distinctiveness of the black and white psyche, on the other. Their research in comparative psychology, however, ultimately failed to yield any concrete empirical data on racial differences in the etiology or symptomatology of mental illness. In this sense, racial difference remained a problematic concept in psychiatric thought. As much as psychiatrists attempted to reify race as a scientific category of human variation, they ended up relying on vernacular understandings of racial distinctiveness—their own as well as those of their white patients and white society more generally—to make sense of black insanity and to manage their black patients.
This commonplace belief in racial difference, along with the ambiguity of black madness, resulted in therapeutic encounters between white psychiatrists and their African American patients that were marked by overt racism and, more often than not, racial ambivalence. To be sure, these psychiatrists’ motivations for entering into the profession and their commitment to medical humanitarianism should not be questioned. There can be no doubt that in most cases psychiatrists and nurses were driven by a desire to at least understand their patients’ maladies, even if their efforts to heal them were hampered by high patient-staff ratios, lack of resources and time, and so forth—although this claim deserves less confidence in the case of attendants. That desire, however, was too often burdened by a stubborn belief in racial difference. Placing the white sufferer at the center of their vision produced a therapeutic regime at the hospital in which African American patients occupied a marginal sphere. Their relegation was often framed as a necessary component of their treatment, moreover, whether it was sequestration in segregated and inferior wards or coerced labor in the hospital’s laundries and kitchens. In this sense, the therapeutic encounter between white staff and African American patients should not be considered extrinsic to or incompatible with the preservation of a particular racial order within and outside the hospital. Rather, it was emblematic of both the social reproduction of that racial order and the privileging of the white sufferer within psychiatric thought and practice. Racialist thought and racist practices, in other words, cannot be disentangled from the medical care that African American patients experienced at Saint Elizabeths.15
By the mid-twentieth century, there was a significant turn within the psychiatric profession toward a universalist understanding of the psyche, a turn that accompanied the growing skepticism of the reality of race—as a biologically determined and deterministic category of human difference—within academic and public policy circles. But even as the decline in theories of racial distinctiveness, accompanied by the psychopharmacological revolution, paved the way for a race-neutral approach to mental illness, African American patients at Saint Elizabeths still had to deal with the legacy of the profession’s prioritization of the white sufferer.
It was also in the mid-twentieth century that the demographics of Saint Elizabeths began to change. As African Americans increasingly constituted a larger part of the patient population in the postwar period, the institution experienced a decline in its stature as a preeminent research and teaching hospital. This relationship is more correlative than causative, but it is an important one nonetheless. Saint Elizabeths had enjoyed a reputation as being a leader in the field of asylum medicine and institutional psychiatry from the mid-nineteenth century to World War II, when the population it served was predominantly military and it practiced racial segregation. In the postwar period, as the army
and navy stopped sending its active-duty service personnel to the hospital and veterans began transferring into the Veterans Administration system, Saint Elizabeths’ patient population became increasingly civilian and older. With the continued in-migration of African Americans and white flight in the 1950s and 1960s, the patient population also became blacker. Gradually Saint Elizabeths went from being the asylum for the nation to merely “a state institution for a stateless population.”16
Mental Illness and Claims-Making in the Nation’s Capital
Although by the 1970s and 1980s Saint Elizabeths became increasingly defined—both in policy circles and in the popular imagination—by the services it delivered to an inner-city population, those African Americans whom it served were hardly powerless people acted on by large institutional forces. Rather, African Americans, both patients and ordinary citizens, demonstrated a significant amount of agency in their interactions with Saint Elizabeths. Exploring the history of the hospital’s relationship to the black community from within a few years of emancipation to the post–civil rights era provides a fruitful opportunity to examine the role that the government played in the lives of African Americans and the role that African Americans believed the government should play in their lives. In the case of black patients, this book documents myriad examples of people whose actions illustrated their determination to shape the conditions of their existence at Saint Elizabeths. The agency of patients was matched by that of their friends and family, who frequently engaged with the hospital as a way of making claims on the state for equal treatment.
In fact, another aspect of Saint Elizabeths’ exceptionalism figured prominently in how African Americans would interact with it as an institution of the state. For most of Saint Elizabeths’ existence as a federal asylum, Washington, DC did not enjoy home rule and the city’s residents were excluded from the formal arenas of citizenship. After a brief period of limited sovereignty with a territorial government between 1871 and 1878, the District reverted to direct rule by Congress and the executive branch. For the next ninety-plus years, Washington would be governed by a Board of Commissioners, whose members were appointed by the president. Half of the city’s budget would be funded by Congress, in compensation for not being able to tax federal property, and the citizens would have no representation in Congress. District residents would not even be able to vote for the office of president or vice president until 1961. Elite Washingtonians, for the most part white, were still able to influence public policy through the Washington Board of Trade, and racially exclusive neighborhood-based citizens’
associations also provided white residents some access to the levers of local government. Formally disfranchised along with their white neighbors, black Washingtonians sought to assert their citizenship and equality before the law in a variety of arenas, including their relationship to Saint Elizabeths.17
Occasionally, this assertion of citizenship and equality before the law was a collective endeavor. For instance, black neighborhood civic associations advocated for a federal investigation into the conditions at Saint Elizabeths after the murder of an African American patient by white attendants in the mid-1920s. In the 1950s the local chapter of the National Association for the Advancement of Colored People and the predominantly black Medico-Chirurgical Society pressed for the integration of the hospital’s wards. Grass-roots organizations sought to collaborate with Saint Elizabeths to establish mental health counseling centers in public housing projects in the late 1960s, and in the 1970s local residents demanded representation on community mental health center advisory boards and input into decisions regarding the transfer of the hospital from the federal government to the District. Just as hospital and government officials invoked the exceptionalist nature of Saint Elizabeths to tout the nation’s values, African Americans involved in these collective endeavors also deployed the language of exceptionalism. In their case, however, they emphasized the contradictions of the existence of racism in the capital of the world’s leading democracy as a way of furthering their own civil rights claims. Access to and equal treatment within medical services became an important aspect of citizenship for African Americans in the postemancipation period and continued to be so through the twentieth century.18
But equally important, black Washingtonians asserted their citizenship in more individualized and quotidian ways. Just by drawing on Saint Elizabeths as an asset to deal with a problem that was internal to their family or community was an important declaration that they were entitled to the same access to government resources as whites. Moreover, by collaborating with the staff to manage—and in some instances endeavoring to control—the inpatient, outpatient, and postinstitutional experiences of their loved ones, black Washingtonians made it clear that instead of submitting to the medical and governmental authority wielded by the hospital, they would play an important role in the therapeutic condition of their family members. Of course, some patients’ family members abandoned them, and certainly some African American residents of the District perceived the institution to be an overbearing instrument of government power. But just as many interacted with Saint Elizabeths as a deliberate act of making claims on the state that reinforced their status as citizens who were equal before the law. In this regard, African Americans’ engagements with the hospital reveal the existence of “rights consciousness,” what one historian describes as the enactment of
equal status through “less explicit declarations of rights.”19 It was the expression of this rights consciousness—by both patients and their advocates—that makes the history of the relationship between African Americans and Saint Elizabeths Hospital so much more than one that can be reduced to medical racism or social control. Rather, the history of the relationship between Saint Elizabeths and black Washingtonians is a story of health care professionals, national and local government officials, and patients and their communities contending with one another over the important role of race in understanding mental illness and in providing care for those who were afflicted by it.
A Note on Names and Language
In writing a social and cultural history of race and mental illness in the nation’s capital, I have relied on the case files of patients at Saint Elizabeths. The case files are stored at the National Archives and, while access to the more recent files is governed by the Health Insurance Portability and Accountability Act of 1996, the ones that I have used are open to the public. Nonetheless I have decided to shield the identity of patients unless their commitment to Saint Elizabeths is clearly indicated elsewhere in the public record, such as a newspaper article or a transcript of a congressional hearing. In an attempt to protect their privacy, I have not changed their first name but have used only the first initial of their last name. When referring to or citing a relative of a patient who has the same last name, I have used the same method. In cases where the identity of a patient might be revealed by using the real name of a friend or a family member who has a different surname, I have assigned a pseudonym to the latter. I clearly indicate in the notes when I have done so.
The hospital that is the subject of this study began its career with the title Government Hospital for the Insane. Almost immediately, inmates, their families, and the staff itself began using the name Saint Elizabeths—in reference to the name of the tract of land on which the hospital sat—in an effort to strip commitment to the hospital of any stigma. The name of the hospital was not officially changed to Saint Elizabeths until 1916. Nonetheless I have chosen to use this name throughout the book. I occasionally use Government Hospital for the Insane—especially in the early chapters—when to do otherwise would change the context of a particular reference. For those intimately connected to the hospital, it has always been Saint Elizabeths, with no apostrophe, even though journalists, editors, and ordinary folks want to turn it into a possessive. The hospital’s name is often written as Saint Elizabeth’s or Saint Elizabeth. I have chosen not to use the intrusive sic when quoting or referencing a misspelling of the name.
