Special Episode: Antonia Hylton & Madness

the season. If you want to read ahead or see what books we've covered in the past, head over to our website This Podcast will Kill You dot com, where you can find a link to our bookshop dot Org affiliate page under the extras tab. Once you're on bookshop, you'll be able to spot a bunch of different TPWKY booklists, including one for this book club. Throughout the rest of this season, I'll be posting upcoming books, so make sure

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and subscribe. It really does help us out. And second, you can now find full video versions of most of our newest episodes on YouTube. Make sure you're subscribed to the exactly right Media YouTube channel so you never miss a new episode. Drop. It is twenty twenty five. We are a quarter of the way into the twenty first century, and we are still failing in many ways to deliver

mental health care to those in need. Stigma, shame, dismissal, sexism, and racism are all embedded in the way we view and treat mental health issues, affecting who is deemed worthy of receiving care and what type of care they receive.

And as the police have increasingly and inappropriately been called on to respond to mental health health crises, Black Americans and other people of color experiencing a crisis are disproportionately more likely to be harmed or killed by police, imprisoned, rather than given the help and mental health resources that white Americans are more likely to receive. The roots of these inequalities, which are ingrained in our current medical andcarceral systems,

stretch back generations. To make lasting and effective changes in the way we approach mental health in this country, we need to turn to the past to understand its role in shaping are present in madness, race, and insanity. In a Jim Crow Asylum, author Antonia Hilton explores the story of Crownsville Hospital, a segregated asylum in ann Arundel County, Maryland, built in nineteen eleven by its first patients, twelve black men.

Over the decades of its operation, during which it grew into a compound housing thousands of patients, Crownsville became, in anyways, a microcosm of the dynamics between race, mental illness, medicine, and the civil rights movement playing out across the United States.

Expertly blending oral histories with archival materials, Hilton, who is an Emmy Award winning anchor and correspondent for MSNBC and NBC and New York Times bestselling author, presents a nuanced and moving examination of an overcrowded, understaffed Jim Crow institution that shaped the lives of those who lived or worked there. Hilton also reveals how the shift in focus from asylums

to prisons in jails was reflected in Crownsville's operation. Madness is an urgent, necessary, and powerful work that sheds much needed light on the intersections between race, racism, and mental illness. I'm really excited to share this conversation with you all, so let's take a quick break and get started. Antonia, thank you so much for joining me today.

freshman year. I'm trying to figure out who I want to be and what I want to study, and I stumble into a class called Madness in Medicine that I didn't even know was something that could exist, A course all about the history of mental health care treatment in the Europe in the United States, and I learn all about the development of the asylum, the development of medications to treat mental health challenges, and as I grow deeper and deeper into the course, there's this thing gnawing at me,

which is that I'm learning about the history of mental health care mostly from the perspective of European or white

American people. And I knew something was wrong with that, not just from you know, basic instinct, but because I have family members who were very deeply impacted by the system themselves in the US history of mental health challenges in my family, and so I knew that there were black people, black patients, black providers who worked in these spaces, who contributed and tried, and I just went looking for

a way to learn more about that at first. And so I go looking to find out about the asylums the institute US that worked with black patients, And what I found was a system of segregated asylums built in the decades after slavery came to an end in the US, and many of them closed down, were the subject of scandal, burned, files, destroyed. There's one asylum that a great grandfather of mine spent some time in that has been turned into a kind of Halloween theme park sort of experience. Yeah, I made

the same face when I first found that out. Wow. And so in many cases I just kept hitting these like dead ends. Okay, not much here, there's just a paragraph about it here. And then I found Crownsville. And Crownsville is unique and not unique in a number of ways. Unique in that it is one of the only ones that were part of this network, a segregated asylum with existing records, living people and patients who had been at this place, and a campus that is still standing even

to this day. In fact, it's in really the heart of Maryland, in an Arundel County, and the county and the state is engaged in a massive sort of rehabilitation and reimagining project as we speak. And so there was this opportunity to feel the place, to see it, to walk through it, to talk and sit with people who knew it intimately, and then to also petition the state of Maryland for access to its records. And that was

unlike really any other opportunity. I'd say. There's one similar place in Virginia called Central state that there's similar opportunity there, but this was so rare, and so I just dove in and I became obsessed. The longer story, and perhaps the more true story, is that when I was eleven years old, I had a conversation with my father about, you know, cousins, and my cousins had just been visiting our house and I asked my dad, you know, I guess something must have clicked in my I had, Hey,

why haven't I met any of your cousins? Do I know any of your cousins? You must have some And he said, well, you know, there's an uncle who you think is an uncle, but he's technically a cousin, but you call him uncle. And that's something that I know many people can relate to. And then he said, and then you know, some of my cousins have lost touch

with them. One was incarcerated, and then one was killed by a police officer in the middle of a mental health episode, and we don't talk about him very much. And that was my first time ever learning that my dad had had a cousin named Maynard growing up, who he had loved and admired. He kind of wanted to be Maynard and in many ways, he actually did follow

in that cousin's footsteps. My dad is a lawyer. Maynard was a lawyer when my dad was little, and he developed schizophrenia and was killed by a police officer during an interaction in public on the steps of a federal building in Mobile, Alabama in the seventies. And I was too young at the time to talk to my father about that. I didn't really know how to ask good questions. But then I became older and I asked a little

bit more. I became a journalist, I became a pest, and I started to understand who Maynard was and just how much his death had transformed my family. And I think that in a way, for me, this story really goes back to my childhood, to the discovery that there had been all these stories in my family, these experiences people who had tried and failed to seek treatment in

the system that set me on this path. Made me so curious in my bones to try to understand this that it set me up to be in a place where then when I am this young student, it all kind of clicked together. And so that's why I always tell both of those stories, because there's this sort of surface level story. But then there's like the what said times has felt for me like this, like familial mission I have been on almost like I don't know so

much that I had a choice. It just sort of feels like all these things fell into place and they were right, and they were the thing I had to do, and that is what brought me to Crownsville and to this unbelievable story.

mental health care. And I want to go through the full story, but I want to touch on something that you mentioned early on, which is the difficulty in obtaining source materials. And I'd love to hear more about your research method and your process for incorporating these different types of source materials together, like which elements do you pull from? What was that entire experience like for you.

really guide me through this. I don't know that I would have gotten it done without them, but the process of going through Institutional Review Board Human Subjects Research Approval and getting the State of Maryland to give me permission to come to the state archives and access records that they typically refuse to share. In fact, it's a point of contention for many people in the black community in Maryland who have routinely asked for access to these records

and been denied it. And so I think I didn't appreciate how hard it was going to be. I thought, Okay, there's some rules on this website. I'm going to follow all the rules. I'm going to take the tests they tell me to take, and then they're going to let

me go. But you know, there were some politics that got into the way and some people that dragged their feet, and so it was helpful to have the backing of that institution to come in and sort of apply some pressure to make sure that I could get in there and get my work done. And so that was to me. I thought, like, Holy Grail, I'm going to go into the state archives and everything will be there. I will know everything about this place as soon as I can

get my hands on these primary source documents. And then I finally do, and it is incredible. Let me not downplay what's in there. I mean, there were monthly reports. There were writings and letters that superintendents who ran the institution had written to themselves or privately to other state leaders. There were certain patient records, but whole lot of patient records missing. And I very quickly realized this wasn't the

hoil that I thought it was going to be. That most of what happens when an institution of that nature closes down and people preserve what remains is the sort of clinical perspective and the leadership perspective is preserved, but the patient story that is not respected that's not maintained, that's not preserved as as well. And in fact, as I later learned in my journey, I didn't know this

at the time. Employees of the institution alleged that there was a systematic effort to destroy a lot of the patient stories because there was a fear from the state in their view that perhaps lawsuits could come from that, that it would be more trouble than it was worth. And so I realized, even as a very young person sitting there in the Maryland State Archives, oh wow, I'm going to need to launch like a big oral history project. I need to go talk to people. I need to

meet people. I'm going to need to make up for the voices that are missing in this place and find them elsewhere. And that it took a long time because humans are human and you have to build trusts with people. You have to call them, write them snail mail. I mean a lot of the former employees they were at the time and they still are quite elderly, and so I couldn't text them and DM them on Instagram or something. I had to really do some like shoe leather reporting work.

And in some cases there were some people I was able to meet very quickly Pauler's for example, Paulers worked at the institution for forty years, social worker who dedicated his life to children at Crownsville. He was very quickly willing to speak, but so many people had been affected. I'd been traumatized in some cases by what they experienced at Crownsville, and so it took a while to build

their trust. There are people in this book who took three, five, seven years to decide to talk to me, and I had to be really patient with that and respect that there were people who didn't want to talk on the phone, but they were willing to talk if I came and knocked on the door and I sat on their porch. And so the level of investment and patience that comes with that, I really I grew into it in a way.

I started out as this young person who was just calling people up, and I should be grateful that anyone answered to a nineteen year old's phone calls. First of all, let me say that. But then I became an adult and a professional journalist, and I got the resources to be able to do the sort of real like sitting in the community and being present work, and that is what transformed everything. I think those stories, those memories, they are the richest part of this book. You know, the records,

they are fascinating, They are valuable. I worked with so many of them in the story. But it's so helpful to have the sort of sites, smells, sounds, and stories from people who were so personally impacted by all this, whether they were the patients or they were the providers, and in many cases they really fill in critical gaps or you know, the records in some cases actually confirmed some of the stories that were found out in the community.

And with an institution like Crownsville, it's huge for anyone listening who lives in the Maryland area, like it is worth driving by and seeing this place because you'll get a sense of just the immensity the number of people who were touched by this place over the almost one hundred years that it was in operation. And what comes with that is there's amount of community rumor and storytelling and all of that that you have to wade through.

And having the community and having the trust in the community, and then having the records and bringing those complimentary pieces together, it allowed me to find a way to tell a story that had either been both sort of simultaneously pushed under the rug but also sort of festered as a mythological thing for a really long time. And it was the ability to do both of those things that helped me find the truth, the core of what happened there.

And I see the record, the sort of painstaking archival and research process as being just as important as the oral history endeavor to.

one sided, one dimensional, or just one perspective. And that's one of the things I really appreciated about your book. And I would love to turn to the beginning. Why was this institution and other institutions like it? Why was it built and how did its surrounding context both the time period in which it was established and the location that it was established in how did that shape what it would become.

in places like Tulsa, Oklahoma, and they're gaining ground. But then there is a massive backlash and backsliding that starts to steal some of that ground back. And there's an effort and a lot of that effort actually begin in Maryland. A lot of people don't know this. You know, Maryland passed one of the first segregation ordinances in the entire country, if not I think the very first segregation ordinance in fact. So there is this effort to try to put black

people back in their place. But there also is for the black people who you know, haven't found the Tulsas, who haven't maybe found their footing yet. There's this sort of incessant writing going on in white intellectual circles. So doctors, lawyers, politicians who are really obsessed with what they describe as

this problem of Negro insanity, Negro alcoholism, Negro waywardness. They are observing that there are all these black people who seem to be traumatized and struggling and unable to adjust to life post enslavement. And you know, looking back on it for us now, that perhaps doesn't seem so surprising that people found that experience, you know, hundreds of years of enslavement to be traumatizing for their families. But at that time, you would think think they thought that everyone

would get over it in a year or two. That just simply hadn't been the case. So they're writing in these letters to each other or they're publishing in medical journals these observations that were incredibly dehumanizing. On the other hand, then they're expressing pity and saying, well, we need to do something about it. We got to do something about it. But what they decide to do is create a place

to treat them. But they must be separate from white people because these antebellum attitudes that black people are inherently different, they seeped into everything. I mean, I think people understand, okay, separate Water Fountain, separate schools, but they forget I mean, it went into healthcare treatment. It meant into basic conceptions

of how the mind in different people would work. And so they make the decision that there need to be these separate places for treatment, and Maryland takes it one step farther. They decide that they're going to create this asylum, but they don't really want to pay for it, and they're going to ask, not ask, They're going to force

these patients to build it for themselves. So it begins with twelve black men who are brought from almshouses, poorhouses around the state, brought into a forest and if you know the Maryland area, it's sort of the modern Bacon Ridge natural area, and there's nothing there, nothing, not a place to sleep, no cabins, and they are told they have to get to work, build yourself an asylum, move railways, move tracks, construct roads, clear ground. I mean really monumental labor.

They're working side by side with contractors hired by the state, but the patients did an immense amount of the backbreaking, really physical labor. And weeks go by as they're doing this, and they bring new patients in and new men in

and actually also boys. There are state records describing you know, putting boys who are about ten to twelve years old who are disabled, physically disabled to work and being proud that they were able to get them to carry you know, pails of water or other items around and get them

to contribute to this effort. And the sort of tone is always that they should be grateful that they're given this work, that it must make them feel better, you know, and that once this project is done, they'll march into the rooms that they just built and they'll become its first patients. So that is how Crownsville begins, and that is the racial and political context at the time.

of what was available was terrible for everybody. I mean, if you actually talk to psychiatrists and biochemists and to therapists and people who work in the space today, they'll still tell you that we may be in the dark ages of understanding how the mind works at this current moment. So certainly nobody's going to argue that what was available

in nineteen eleven was incredible. And you know that there were quick fixes all around, No, not for anyone, But there were ways in which leaders made very deliberate decisions to give people of color the absolute worst of what was available. You know. For example, they knew that tuberculosis was an incredibly dangerous disease that impacted people's physical and mental health, but they were careful to create separate, quarantined wards for that. At all white institutions, they refused to

do that. However, at Crownsville, they knew that this disease would kill or physically and permanently disable all kinds of people in these in Crownsville, but they allowed it to fester anyway. That was a price, a sort of just a reality they were willing to accept, despite writing and openly knowing that to do the opposite was the right

thing for another set of patients. And the other interesting thing I should say too, is a lot of these therapies are complicated to talk about because they may sound horrible at first, but there are clinical arguments that have

been made for them. For example, electro shock. A lot of people horrified by the concept of electroshock, but there are still people doing electro shock to this day, and there are patients that will tell you that they love it, and so you know, while at Crownsville there are a lot of stories of abuse of patients through electroshock, there are stories of clinicians believing that it was a valuable tool that helped them gain insight and make treatment breakthroughs

with patients at places like Crownsville too. Hydro Therapy is another example. Hydro Therapy is a tool that for some patients could be incredibly relaxing. It was the experience of being submerged up in water in a tub sort of up to right under your chin, and you would be either an incredibly hot or incredibly cold water for a period of time. That period of time could be a couple hours, it could be up to three days. At Crownsville, now, spending a couple hours in a very warm tub for

some patients was apparently in some cases very relaxing. Spending three days in a very hot or a cold tub, some would call that torture. And so every single one of the sort of modalities available, you can pause, or you can do the reading and see a completely different way of looking at its application and the potential for harm. And so there's sort of the baseline story of what was available and how difficult and how dark the treatment

of the mind was at that time. But then there's also just sort of the need to understand that as you look at the different kinds of facilities that always what you saw was the same pattern repeated, not just in Maryland, but certainly that's the place that I studied, that the black patients were going to get the worst of what was out there, and we're going to have the fewest sort of clinicians and aids available to support them.

I write at one point about records that I found that showed that as the state rehabilitated a bunch of the different asylums in the state, that they sort of consciously made the decision to build less therapy spas at Crownsville. So sort of this idea that there was going to be room for patients to even just have space to talk, to reflect, to work with and be in conversation with a provider. You see the way in which sort of

attitudes are reflected in expenditures and structural decision making. I know people don't love talking about structural racism anymore, but you see a lot of it, very obviously in the story of Crownsville. And so it's complicated because there are these moments in this story where people are able to do genuinely great work with patients at Crownsville, especially after integration and more members of the community are able to get the chance to take care of people who look

like and who know them. But there are also there's also the element of horror. There's also an absolute reality of abuse, and all of those things existed and coexisted and could happen on any given day at the very same time.

into some more questions. The way that this plays out is such a nuanced way, where you have these prevailing notions about how the mind works, how mental illness works, and then also you have this racism that's baked into so much of the way that that is informing that a lot of the physicians, for instance, who are providing the treatment and so on, and then and of course

funding and all of that. And initially it seems like for at least a period of time, Crownsville's predominant role was not too necessarily, or maybe it was in combination to provide care for those with mental illness, but also to exploit those individuals for their free labor. How did this factor into how long someone was held at Crownsville or was lived at Crownsville, And when did awareness of this sort of mistreatment or these instances of mistreatment seep into the surrounding communities.

themselves a hospital. So the exploitation begins before the hospital has any sort of physicality to it, and then when the hospital opens and its operations start, that is really just the beginning of very long workdays for the majority of the patients there. Unless you were essentially completely physically disabled, you were expected to offset the cost of your own care for many decades, the first essentially three four decades

at Crownsville. There is this massive pressure on patient labor there in areas that were unusual to so in the twentieth century, there was a very common concept actually even before that, of this idea that having vocational training for patients, for people struggling with their mental health would be good

for them. It would mean that when they get out they get great jobs or they have an apprenticeship, they have opportunity, or at least they can be helpful to their families if they're staying at home, and so Lots of asylums had jobs, programs or chores that patients needed to do, and Crownsville was no different in that respect. But the hospital had an entirely other layer of labor expectations.

Unlike anything seen in Maryland or really most of the institutions I've ever studied, Crownsville expected patient to run a highly modern and productive farm with modern irrigation practices. They farmed tobacco, they worked with cattle. Women were expected to basically constantly be working with food and produce, or in

the kitchen or in the laundry. And it was to such a powerful extent that this is remarked upon consistently in state records, really as a point of pride that we're able to keep the cost down at this place because we made the patients run the place themselves. They were proud of how much they were able to get them to do it. And then even they take it again another step too far. They are extracting from creative patients.

So people who create rugs or did basket weaving, they start to sell their goods, and none of that money comes back to the patient themselves. It's used again to offset the costs of their care. They send items that patients at Crowns will made out to competition, and the superintendents would display and brag about them as if they

were almost theirs. And so there is this sort of constant air of exploitation there, and it doesn't start to shift until really, I mean, I guess it depends on your idea of what a shift looks like, if it's the rumor mill, if it's awareness in the community. The black community became aware of a lot of this very early on. There were a number of patient murders. I write about one, the father of civil rights icon Polly Murray, her father William Murray, murdered by an allegedly pretty openly

racist guard at the hospital. Stories like that they spread among black community members of Annapolis and Baltimore. They didn't necessarily get the attention they perhaps deserved in the papers like the Washington Post or Baltimore's Sun, but they certainly were known about. But real action begins, say in the forties, when there are these sort of budding civil rights movements.

There are lawyers and growing budding associations like the NAACP that are starting to sort of demand access, demand meetings with state leaders and the superintendents of Crownsville and get in there and actually start taking testimony from patients. And then, to give a little credit to my field, there are reporters who start asking questions. At all the major papers, there is a series of expose as, but there's also

some incredible work done. I have to shout out the Afro American newspapers because those reporters consistently published diary entries of patients on the first pages, unlike anything any of the other papers were doing. And they allowed patients to tell their own stories and their own voices, and weren't always taking the word of say the police or the

superintendent above theirs. And so there's a lot of richness there in the record that you can find by looking at some of the alternative or minority media at that time. And so that's when the sort of consciousness that guests starts to shift is in that period in the forties, and in a way it's no surprise America is engaged

in a horrendous world war. The hospital is starting to receive and welcome in Jewish men and women who are fleeing the Nazis and who are coming to restart their lives in the United States, they come to work at places like Crownswell, and they too are outraged by what they see there because they've seen this, They just escaped a system of extinction, and now they come to this place and they see the patient labor and the exploitation

for what it is. And so you have all these factors that are coming together in that period that are leading to these new coalitions that are getting ready to transform this place.

patients it said, oh, well we need to manage. How did this play out at Crownsville.

lawyers are starting to make demands. There's this growing movement in the United States that begins in the forties and really extends for decades onward to rein best in community care, to bring people home, to have more empathy for the patient, to be willing to hear their side of the story, and to share their narratives in the paper, in media and movies. Really there was a sort of explosion. But then what I found is that when it came to

black patients, the communal response was very different. There was a fear about release, there was a fear about what it would mean to welcome them back into the community, and that often reporters in my field then they made a lot of mistakes. They over exaggerated and sort of misreported the extent of for example, escapes or riots at a place like Crownsville, as compared to what was happening

at pure white institutions. And I found records of even superintendents who know none of the patients, would have described as their ally. They would acknowledge that the crowns will the amount of violence or escapes at that site were being sort of unfairly highlight or featured in the papers,

even when pretty much equivalent events were happening elsewhere. I spent some time going through just some of the language the adjectives used by reporters at the time, too, that when they would talk about a white patient who escaped, they would often describe sort of the person's melancholy, how

fearful they were. I remember, I don't think I included in the book, but I remember reading one paper describing a white male patient escaping one institution, and the paper was kind of making jokes about the red fluffy slippers that he escaped into the woods wearing. Whereas and I do include these in the book. I write about some of the young black male patients who are written about as though they are any minute now going to come into the suburbs surrounding the institution and rob rape and

terrify people. And there are descriptions of people saying, you know, after they've heard about an escape, that guns are going out onto porches tonight, and people are sort of fantasizing about this fear of their wives being left home alone.

And there's this sort of juxtaposition always between sort of white domestic life and the threat of the people inside Crownsville again, even though at the same time, the same number of patient escapes are pretty routinely happening at pure white places as well, And so there is a perception that follows then, of course, and what follows from the conversation,

the cultural conversation, the perception is political action. People start advocating to build a wall around Crownsville anyone, I don't know. Maybe they advocate for morelock and key policies. They want to bar patients from being able to visit communities. There's this massive carceral push to keep them behind bars at all costs, even as clinicians keep saying, we know from the evidence from the work we're doing with these patients

that what they need is actually more community support. We need to be able to hire more people they need therapists. There are patients every week getting zero time with therapists or psychiatrists at the hospital. Basically they're just like sleeping there and working there all day long. They're not actually getting the treatment and rehabilitation that this place was supposed

to provide. And so there's the people who sort of know the people in the place begging for one thing, but the community, because of what they've grown to fear

and believe, pushing for the exact opposite. And in many cases, the community and the sort of people filled with this false perception they went out and one of the tragedies of Crownswel, and I often use Crownswel to help people understand concepts around structural racism and sort of the ways in which our past informs always our present moment is that because of what happened in Crownzell's founding, that the

state always wanted to spend less money on it. They never invested in its building completely, they never invested in employees, they never invested in making sure there were good doctors and clinicians there. They didn't want to build the proper amount of therapy space. They barely had food and soap available during World War Two, when patients there were literally

suffering and dying. Even when this sort of civil rights movement gets some wins, there's integration and there are changes coming, and there's sort of new standards and rules by which all these places have to operate. Crownsville is operating at a deficit. They're never given back the money they were never provided, and so all these new sort of institutional and legal and healthcare care related laws and regulations come

into place. There are these high expectations of the place after integration, like Okay, let's see what you all can do. But they don't have money. They're operating with an institution never built with what it needed to properly survive, and so they end up kind of stuck in this heads you lose tails, you lose situation, and it's heartbreaking for the institution and it haunts it from the period we're talking about all the way until it's closure in two thousand and four.

one that you discuss in your book. And of course there's another book, the Protest Psychosis, that goes into this as well, where it starts out as this sort of this diagnosis of mothers, homemakers who are burnt out, and then it transforms into this opportunity to pathologize young black men in particular, especially during this period of time. What was happening at Crownsville as far as that goes, or like, was that bleeding into there as well?

at many points. Crowns Will absolutely reflects that story. You see it in the records, but you also see it in really and what I found most interesting was the recollections and the testimony of the people who were there. There's this really just fascinating transition coming out of really the civil rights movement where you start to see all of these clinical changes that they're starting to change that

labeling as you just spelled out. So schizophrenia is becoming more of something that is about paranoia and aggression and all of these assumptions around black men and masculinity, and it's shifting from being sort of pictured or illustrated as a disease mostly of I guess, being withdrawn into yourself, and so it's sort of seen as this explosive thing.

I even show in the book some examples of psychiatric ads and ways in which the conversation and the depiction of who suffers from schizophrenia shifts at the same moment that these movements these protests are happening. There's one psychiatric ad that I'll never forget that depicts a black man like hanging from fiery bars and looks like he's in the middle of a protest that's burning some kind of

city to the ground. And he is the image that is accompanying a medication to treat schizophrenia and other diseases. And so you see that and if you're a person of that time. That is absolutely when you're talking about a time in which there were massive protests. I mean Martin Luther King murdered and that impacted Crownsville. People there process that in real time, staff members, patient, family members, they attended the march on Washington. I mean, all of

this is interrelated. It's all part of the cultural context to the story. So you see it from the clinical perspective, but also I enjoyed hearing the memories of people who could describe it for you less as this sort of academic pattern and more is just the real thing that they saw every day at work. I spent a lot of time with this psychiatrist who actually still lives and works in ann Arundel County, Maryland to this day, named doctor Brian Simms. He was one of the first black psychiatrists.

He really helped pioneer trauma informed care at Crownsville. And this is in the latter part of the book, and he writes about seeing police bringing a boy who's about six years old to the hospital in a karate uniform. He's misbehaved in karate class and he's brought there. He and many other described to me seeing patients you chained to polls while they waited to find out where they

were going to be sent. Within the institution, the sort of constant flow of court committed patients who judges sort of decided were one week maybe they would go to the jail, the next week they were fit for Crownsville, And how doctors like him had to get on the phone and battle it out with judges and try to explain to them what was and wasn't appropriate, what was a clinical necessity and what wasn't, and that it was an exhausting, sort of unpaid part of their labor, and

that they saw a lot of it as incredibly racialized, that kind of the second they saw a black person with pain and confusion and who had perherhaps committed a low level crime, that to them there was this sort of fear of derangement and a desire to have them stuck at a place like Crownsville. And that was really

heartbreaking for the people who worked there. And the way that they tell those stories, they capture it so much better I think than a journalist or an acade even can, And so I tried my best to retell those stories in their voices, but you absolutely see it play out. And the doubly heartbreaking part is that those same doctors then respond by trying to create sort of a community based solution. So, Okay, we're going to create a program where we ourselves drive to visit our patients out in

the community. We're going to make sure they stay on their medications. We're going to make sure they don't go back to court that they because a lot of patients they end up on what's essentially sort of the mental health equivalent of like probation, where any missed appointment could

send you back to the hospital. And so these doctors are committed to trying to get people out of that cycle, because I mean, who among us hasn't missed a doctor's appointment to be told for five years that you can never miss an appointment and put people at a meense risk.

So they sort of put a lot aside in their day to day jobs and drove out there into Baltimore, into all these other neighborhoods to make sure their patients made it anyway, and after seeing immense success, seeing the recidivism drop precipitously, they're told by the state that this isn't a good use of their time, and that the

program needs to disband. And so you saw that lack of compassion and the way in which the attitudes you have about a certain community create a kind of permission structure and a sort of attitude from the top down where anything that would actually solve the problem you claim to be so alarmed about isn't worth spending money on. But the one thing consistently we're willing to do is

behind bars, behind bars, behind bars. And it is absolutely a part of the Crownsville story, and it's something that's stuck with so many of the people who worked there for decades onward.

the asylum disappears and everyone goes to prisons. But that you have to see these institutions as being in conversation with each other and as sharing DNA, being part of the same genealogical timeline, and that it isn't a coincidence that at the moment that we are starting to disband this massive institution that at one point was the dominant institution in the United States and the mid twentieth century,

the asylum was much more prevalent and powerful. There were more people there than there were in our prison system, and so you see the decline of that place and this explosion in the other And Crownswell is a fascinating window into that because again it's you can see how it worked in real time and in day to day

human interactions. I write at one point about a report that breaks down what was essentially going on inside of peer white institutions and Crownsville, which at that point had been desegregated but was still majority black, as they were trying to transition patients out of the institution back to the community. Sort of a simple government study trying to look at what was available to those people in those

different groups as that process unfolded. What they found was that at a peer white institution, there were vocational trainers available, There were counselors and teachers and family members present at these hearings, essentially where someone would get approved to go home or not go home, and they would be connected

with opportunities and resources afterward. The report found that at Crownsville there were juvenile probation officers present, there were often no educators, nobody hiring out in the community, no vocational support, and so there was much more common that there would be someone who had a tie to the prison and jail industrial system, and a lot less likely that there would be somebody who was about to connect that person with a bright future, a job opportunity, and an appointment

to make sure that they stayed on their care schedule. And so even then, as this is happening in real time, there is a knowledge that it's not happening the same

for everyone. This whole idea that we had become so empathetic and interested in supporting patients and bringing them home was not applied evenly to all populations, and so it's no surprise then that our prisons and jails are full of black people, many of whom clinicians CEOs will tell you they think actually need mental health care, treatment and support and are likely regressing in a car soral setting like that. And it's the kind of maddening moment we're

living in right now. I mean, I think about it a lot, in particular as we look at what's unfolding in Washington, d C. And we see this big push to just get the homeless out of there, just push them out, like the President basically saying that he doesn't care where they end up and where they go, but they can't be here. And the idea that well, okay, you either find yourself a shelter or something you're gonna do,

or you're gonna end up in jail. That attitude, it came from somewhere, and we saw all these shifts, and in many ways I describe basically the black patient as sort of the lynchpin that held these negotiations together, through which you can see how so many of these decisions and disparate actions were taken. And that's really one of the key lessons from Crownswell. I think, you know, people they often ask me like how hard it must have

been for me? To write this story and how dark some parts of it are, and I of course agree, and I needed to take a lot of breaks while I did this work, absolutely, But the piece of it for me that's actually incredibly hopeful, not just the amazing people that you meet along the way in this book, but also my belief that if you see where we went wrong and you see how some of these systems were set up, that now, in our current moments, so

many Americans of every background want a better mental health care system, that this is a story that can provide us a window like, oh, hey, this was a poor decision, this wasn't necessary. Perhaps we should listen more to what advocates and doctors are trying to tell us in this moment. And I think that this when you look at Crowns Well, through all these different eras, you can see windows of

opportunity and for change. And that to me is actually a piece that, as strange as it may sound to others, actually gives me hope.

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