Madness: Race and Insanity in a Jim Crow Asylum by Antonia Hylton

America’s Dark Days: A ‘Madness’ Book Review

‘Madness: Race and Insanity in a Jim Crow Asylum’ is one of the rare non-fiction narratives that I found myself instantly drawn to.

As someone who goes through phases of reading non-fiction books, while they’re so often incredibly interesting, I don’t always find them to be particularly engaging reads. They can take a lot of my concentration to fully digest, and I frequently catch myself reaching for an easy-to-read fiction book instead. Madness: Race and Insanity in a Jim Crow Asylum by Antonia Hylton is one of the rare non-fiction narratives that I found myself instantly drawn to. Hylton took a decade to write it, trawling through a century’s worth of records. Madness contains the testimonies of more than 40 former patients and employees of Crownsville Hospital. Its records were preserved at the Maryland State Archives, the homes of former staff members, and surviving copies of newspaper and magazine articles.

Spoilers ahead.

The Blurb


On a cold day in March of 1911, officials marched twelve Black men into the heart of a forest in Maryland. Under the supervision of a doctor, the men were forced to clear the land, pour cement, lay bricks and harvest tobacco. When construction finished, they became the first twelve patients of the state’s Hospital for the Negro Insane.

In Madness, Peabody and Emmy award-winning journalist Antonia Hylton tells the 93-year-old history of Crownsville Hospital. She blends the intimate tales of patients and employees whose lives were shaped by Crownsville with a decade-worth of investigative research and archival documents.

As Crownsville Hospital grew from an antebellum-style work camp to a tiny city sitting on 1,500 acres, it became a microcosm of America’s evolving battles over slavery, racial integration and civil rights. During its peak years, the hospital’s wards were overflowing with almost 2,700 patients. By the end of the 20th-century, the asylum faded from view as prisons and jails became America’s new focus.

Reading ‘Madness’ by Antonia Hylton

In the first 20 pages of Madness, we learn about a Black patient who was beaten to death by a white guard, lynching statistics in the late 1800s, records of medical neglect and misdiagnoses, segregation in the U.S., pseudoscientific beliefs of the time and horrifying stereotypes. One belief was that “a Black person’s desire for autonomy and mobility was the byproduct of a self-indulgent lifestyle, that [they] had no pride in their ancestry, no ideals, and no lasting adherence to an aspiration of worth.” With that being said, Hylton’s book is by no means an easy read. Someone who is looking for a light, cozy story to pass the time, should avoid this book for the time being. However, it is a thoroughly researched, absolutely heartbreaking, and exceedingly important tracing of how the darkest parts of American history are still very much alive in modern health and justice systems.

The Mental Health Struggle

Madness takes the reader on a journey through Crownsville Hospital, one of the last standing segregated asylums in America. Hylton weaves first hand accounts and remaining records, highlighting the shocking abuse of society’s most vulnerable people in this particular hospital, but also in Jim Crow states as a whole. That is, before the civil rights movement ended formal, legalized segregation. In an interview with NBC, Antonia Hylton stated that she became fascinated by the history of mental health in America, but found as she engaged with further research on the topic, that Black narratives were repeatedly absent from accounts.

Through her research, Hylton learned about her own family history with trauma, mental health, and police brutality. In one especially poignant section, Hylton interviews a cousin of hers named Kendal, whose brother was killed by police in the 1970s while he was in the midst of a mental health crisis. Kendal says, “It still hurts the same way after all these years. But talking to you is helping me. It feels good to revisit. Isn’t that what you want? I don’t want it to not hurt anymore. It means I’ve forgotten something.” These few sentences alone sum up the importance of Hylton’s work in drawing attention to the stories which have been forgotten to history, as well as the significance of having empathy and knowledge, to prevent these kinds of injustices from happening again.

Inhumane Conditions

Much of the book contains examples of medical abuse and neglect of patients at the hospital. It’s no surprise, considering that at its peak, the hospital’s population was 2,700 patients, despite the fact it only had space for about 1,500. The book also notes that by the end of the 20th century, asylums became less commonplace. In their place, prisons increasingly became the response to those grappling with mental illness, especially for those from marginalized communities.

Abuse of patients ranged from housing children in buildings with those deemed “criminally insane” to patients being forced to share one bucket of water per day for drinking and cleaning themselves. They were also forced to sleep on wooden benches and straw. Since facilities were so scarce, there was only one bath between 90 patients. Many former patients and staff reported that those housed there were physically beaten and hosed with freezing water. A 15-year-old mute girl even died from her injuries after being forced into various experimental trials that neither she nor her family consented to.

Despite there being more widespread discussions about mental health after World War II with the release of films like Psycho, Truman Capote’s In Cold Blood adaptation, and One Flew Over the Cuckoo’s Nest. And yet, the mental health of Black Americans was still rarely discussed or represented in the media. While Maryland’s white population seemed sympathetic to white veterans struggling with PTSD, they expressed concerns about violent Black patients escaping the hospital or being re-released into the area. When patients left Crownsville, one commissioner described this as “escape,” while white patients were described as “leaving without permission.”

On Stolen Time

One large section of the book details how many patients weren’t actually in need of treatment, but were picked up for various inane “offenses.” Marie, a former nurse at the hospital, remembers helping many leave the hospital. On one occasion, a female patient caught Marie’s attention after realizing she’d been at the hospital longer than most of the patients. When Marie looked into it, she found out the patient had been admitted because she stepped into a busy road, startling a nearby horse. This horse then reared backwards, frightening its white rider. For the crime of accidentally frightening a white woman, she was hospitalized for years.

Marie remembered two instances where patients approached her to say they didn’t belong at the hospital and wanted to contact their family. Many white staff members ignored these pleas. One patient was at the hospital for twenty seven years, and when the nurse became worried about how isolated and withdrawn the patient had become, she contacted their family. They were in shock, assuming that all of this time their relative had been dead. They immediately brought him home. 

Barbara Shank, a nurse at Crownsville, noted that many patients were brought there under the guise of anti-vagrancy laws. Patients slept on the streets or got drunk and simply woke up at the hospital — sometimes destined to stay for decades. Some even claimed that civilians were paid $25 by supervisors for bringing in new patients, supposedly “cleaning up the streets” of drifters. While Hylton couldn’t find any record of such transactions, she noted that if this practice was real, it was likely done off the books. Multiple staff members confirmed the allegations to be true.

A Lasting Impression

Every time you think that Madness has told you about the worst moments of Crownsville, Hylton hits you with another account of injustice. While the details of these stories are of course difficult to read about, she deftly tells them with so much compassion. The people she writes about are never a simple statistic. It’s clear that she’s deeply emotionally invested in the stories of each and every one of those who suffered at Crownsville.

She also has considerable empathy for the workers, especially those who were Black or Jewish. They were afforded so few other opportunities, and did whatever they could to make Crownsville a slightly more tolerable place to be, from using their own wages to buy washcloths for patients to welcoming them to stay in their homes when they were released. Crownsville is not an institution I was familiar with, but since reading Madness, the hospital and every person who stepped foot inside over its 93 years will stay with me forever.


Over the years, Crownsville had developed into a dumping ground — a place that seemed to swallow the undesired, poor and nonconforming Black residents of Maryland and, at times, deny them fundamental human rights. Black employees, many of whom came from the same neighborhoods and conditions as their patients, found themselves working under impossible and ethically compromising conditions. They were not always that their work was enough to outweigh the harm, but the alternative — a return to the days of white-only professional staff seemed far worse.

Where to Buy ‘Madness’ by Antonia Hylton:

Header: Madness: Race and Insanity in a Jim Crow Asylum by Antonia Hylton (Hatchette Book Group)

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