‘Blacks Are Immune From Mental Illness’

Historically, concepts of race and mental illness have been intimately linked in American psychiatry, policies, and public opinion. Starting in the 1700s, two diametrically opposed medical views were alternatively used to predict vulnerability of black populations. From 1700 to 1840, enslaved blacks were described as immune to mental illness. John Galt, M.D., medical director at Eastern Lunatic Asylum in Williamsburg, Va., hypothesized that enslaved Africans were immune from the risk of mental illness because they did not own property, engage in commerce, or participate in such civic affairs as voting or holding public office. The immunity hypothesis assumed that the risk of “lunacy” would be highest in those populations who were emotionally exposed to the stresses of profit making—principally wealthy white men.

Controversy over the 1840 census may have helped influence the passage of legislation in Virginia that allowed enslaved Africans qualified admission to Eastern Lunatic Asylum. Three conditions were included in the legislation that circumscribed their admission: (1) no enslaved Africans could be admitted without a petition from their owner or person who held jurisdiction over them; (2) the petitioner had to pay for the inpatient care of the enslaved; and (3) the admission of an enslaved person could not deny admission or treatment opportunities for white residents. From 1765 to 1868, fewer than 100 free or enslaved blacks were legally allowed admission to Eastern Lunatic Asylum.

Findings from the 1840 census purported to show that free blacks in northern cities experienced significantly higher rates of mental illness than enslaved blacks in the south. However, this conclusion failed to acknowledge that mental institutions in the South were restricted by law from admitting slaves. The purportedly higher rates of mental illness in Northern states were attributed to the inability of blacks to manage freedom, and their repeated efforts to escape slavery by migrating to northern states was characterized as pathological. Race-specific symptoms and hybrid diagnoses (for example, draeptomania) were coined to explain predictions of exponential increases in incidence and danger from idle black men if freed.

In 1848, the Association of Medical Superintendents of American Institutions for the Insane appointed Virginia’s two medical superintendents, Galt and Francis Stribling, M.D., to develop a report to inform and guide public policy on race and mental illness. Galt believed that there was no medical rationale for separating people with mental illness by race although he agreed that slaves should be excluded. After state legislation was passed in 1848, Galt provided admission to enslaved blacks if their owners paid for their care. Stribling, the superintendent at Western Lunatic Asylum in Staunton, Va., opposed the admission and treatment of blacks in his asylum. Despite their differences, the 1848 report written by Galt and Stribling recommended that the states adopt a policy to segregate asylums by race. By 1865, Stribling’s proposal that Virginia develop a separate hospital for blacks was consistent with the expectations of the Freedmen’s Bureau. Segregation quickly became national policy, which may have influenced the quality of mental health care for blacks into the 20th century.

Blacks could receive care until the “immunity hypothesis” was displaced. Regrettably, the exaggerated risk hypothesis predicted excess mental illness, dependency, and dangerousness of black people if slavery were abolished. From 1860 into the 20th century, free blacks were seen at the greatest risk of mental illness. The causes included poverty, urban living, adverse family structures, and migration. The exaggerated risk hypothesis supported increased hospitalization of blacks as a means of control and safety.

After the end of the Civil War, Howards Grove Hospital near Richmond provided limited health and welfare services for newly freed slaves. But in 1868, the Freedmen’s Bureau negotiated with the Virginia legislature to accept the hospital as the first mental asylum for blacks in America. The opening of the Central Lunatic Asylum for Colored Insane was based on the prediction that thousands of newly freed black people needed mental health care.

Rates of admission and frequency of severe diagnoses at Central Lunatic Asylum increased significantly in patterns that supported dire predictions of rampant illness. From the 1870s to 1899, the number of admissions increased almost sixfold. However, the most significant increases came during the Depression years, when close to 10,000 people were admitted compared with 1,200 in the preceding two decades.

In 1895, the Central Lunatic Asylum for Colored Insane was renamed Central State Hospital. (Its first black director and medical director were hired in 1985 and 2000, respectively.) From 1868 to 1968, the hospital remained segregated by race and was the only hospital in the Commonwealth of Virginia that accepted African-American mental patients. The hospital has maintained over 800,000 documents that provide details on the institution, patients, and staff. For example, the documents provide 32 characteristics of each person admitted from 1868 to 1942. Current state law allows access to documents that are 75 years or older; however, access by families and scholars to these historic records has been limited.

The Andrew Mellow Foundation provided support to the University of Texas at Austin in 2008 to digitize the entire collection and develop a digital library. The project adapted existing software to increase access while maintaining legally required protection of health information. The digital library project will conclude later this year with open access to its archival findings and methods. Once the records are posted, information on how to access them will be published in Psychiatric News. ■