In 1875, Judy B., a Black woman, was admitted to St. Elizabeths, the Government Hospital for the Insane in Washington D.C. Except for her initial diagnosis of chronic dementia, her medical file remained sparse until the early 1900s, when she was in her 80s. After that time, doctors noted that she sometimes spoke out loud to long lost relatives. Once, she conversed with the man who had enslaved her. Many of the notes pertained to Judy B.’s attempts to catch witches.
Judy B.’s case was included in an article by a white doctor at the hospital, who considered the patient’s belief in witches a sign of a primitive spiritual worldview — and racial inferiority. The article’s central premise was that Black people’s religious beliefs were indicative of psychosis. As Judith Weisenfeld details in her compelling and richly-sourced book, Black Religion in the Madhouse: Race and Psychiatry in Slavery’s Wake, this was part and parcel of a broader assertion made by white psychiatrists that Black religious expression was evidence of insanity.
Medicine had offered a way to launder racist beliefs during slavery, with U.S. doctors claiming that the enslavement of Black people was justified by their physiological characteristics. In the decades after the Civil War, the mental health of Black people became a major preoccupation of white psychiatrists. The growing authority of the field provided a basis for the institutionalization and sterilization of Black people. Ultimately, white psychiatrists pontificated on the ability of Black people to live freely and participate in civic society.
“White psychiatrists’ theories about Black religion and mental illness promoted claims of African Americans’ unfitness for freedom and bolstered broader arguments for political disenfranchisement and social marginalization,” writes Weisenfeld, a historian of religion at Princeton University.
The book draws on hospital records, court proceedings, newspaper accounts and other documents from a post-Civil War white society that strove to portray Black people as unstable and irrational. During this time, white physicians claimed that diagnoses of insanity among southern African Americans were skyrocketing. Many cases were attributed to “religious excitement,” considered a state of “excessive or disordered religious belief and practice” that could leave someone deranged. White psychiatrists saw Black religious life as type of “religious excitement,” and therefore a form of mental illness.
The white psychiatrists and other medical authorities expressing these opinions had enslaved people or grew up in families that had, Weisenfeld reveals. As these physicians doled out diagnoses of insanity to Black patients, they claimed that the increase was proof that Black people couldn’t handle their newly gained freedom, that emancipation was a mistake. As a Richmond Times headline put it in 1900 when it published a Virginia medical professor’s lecture, “Freedom Fatal for the Negro,” subtitled “Insanity’s Ravages.”
It was Black religious leaders who initially challenged the white psychiatric consensus on African Americans’ mental wellness. By the 1930s, they were joined by the growing number of Black physicians and psychiatrists. The argument that racism and unequal treatment led to poor mental and physical health took stronger hold.
Medical racism has not been left in the past, and the parallels between “religious excitement” and the discredited term “excited delirium” show the endurance of racist views regarding Black people’s mental health. Put forth in the 1980s, “excited delirium” gained traction as an explanation for deaths, disproportionately among Black men, that have occurred in police custody, a way to discount the brutal use of police force. Authorities have “invoked excited delirium to explain both the agitation the victims exhibited in their encounters with police and their deaths,” Weisenfeld writes. This term is not recognized as a diagnosis by the American Psychiatric Association or the World Health Organization.
Beyond the detailed historical journey, I especially appreciated the care Weisenfeld took in recounting the lives featured. What information remains often comes from white doctors or judges in medical records or court cases. The stories and experiences of the people who were institutionalized are mostly lost.
So I found the glimpses I got of Judy B. and the circumstances she faced all the more moving. Doctors noted that Judy B. did not know her age or how long she had been at St. Elizabeths. But as Weisenfeld points out, imagine what decades of confinement would do to your sense of time. Imagine being assessed with a memory test that asks the date of your birth, when, as a formerly enslaved person, this information may have never been known to you.
And then imagine the worry of Judy B.’s daughter Hattie. Weisenfeld found letters Hattie sent to the hospital, wondering why she hadn’t heard from her mother. One letter mentioned a fabric Hattie sent to make a dress for Judy B. Weisenfeld tried to find what became of Hattie but came up short. Judy B. died in the hospital.