Race and Madness: Racial Mistreatment of Individuals of African Decent in Lunatic Asylums, 19th Century to Early 20th Century

  • George Tapscott
  • Written as an assignment for the course HIST/FRSC 3711H - A History of Incarceration at Trent University.

    Racism was prominent in lunatic asylums of the 19th to 20th century all over the world. The Victorian period and the enlightened ideals that shaped racial attitudes in the past are illuminated by various primary sources of patients in lunatic asylums and mental hospitals. This essay will focus on the treatment of patients with African decent by their European physicians and experts who managed the institutions. Despite the lack of medical records that specifically emphasised the racial background of patients, the staff of lunatic asylums often treated and categorized patients based on their ethnical background. Patients with African decent were viewed as inferior and susceptible to certain mental illnesses, and diagnosis of patients often reflected the racial prejudices held at that time. The segregation within the walls of the asylums represented the discrimination that existed in societies during the 19th to 20th century, where the patients were dehumanized and treated wrongly too often times. The relationship between race and madness in lunatic asylums, where patients were treated with extreme racial prejudices signify an important part in the history of incarceration, and it serves as a reminder of how intimately connected race was to a patient’s treatment in institutions of the past.

    Race as Important Factor in Patient Categorization

    Although race or ethnicity was a secondary defining characteristic of patients admitted in the asylums of the 19th century, and was often omitted in the official documents, it is important to specifically look at race when looking at patients in asylums. Race was not officially included in the description of an individual in his or her medical certificate in, which served as both a medical and legal document in American asylums1. It was rather the patient’s class and gender that were more emphasised in the patient’s medical records when asylums processed their patients2. However, race would inevitably play a significant role in distinguishing a patient as insane. Not only factors social class or gender, but race should be taken into observation when studying the lunatic patients of the 19th to 20th century, as it was a significant part in how they were viewed and treated inside the asylums. The way in which race would surface as a factor in treating patients is how doctors and experts described patients of different origin other than European is illustrated by a report from the Robben Island Lunatic Asylum: “With regard to Kafir, the closer you can assimilate his condition to that of his normal state the better. I think it would be a mistake to confine Kafirs to a house and tie them to one spot. For that reason I think the asylum on Robben Island is particularly suited for the natives.”3 Kafirs was the term used to describe the indigenous culture in South Africa, and they were treated as a race, rather than as individuals by the experts in the asylum. Such use of ethnic identity in defining and deciding treatment plans is a reoccurring theme in the history of lunatic asylums, and it shows that race was indeed an important factor in a patient’s experience in the institutions.

    In the colonial and post-colonial period, people of colour or African decent were continuously stigmatized in the medical hospitals, where they would be seen ultimately different from white patients. Description of the African cultures as possessing a “'lack of personal integration' in adulthood.”4 or “'small brain, natural lobotomy' kind"5 illustrates inevitable racist attitudes that existed against the patients. The notion that the brain of a primitive race, such as those with African decent or aboriginals or any other non-European, was less developed than that of a European was a popular thought in psychiatry until the middle of the 20th Century, and played part in many academic works6. These writings on the African race continued throughout the 20th century, and contributed to the racial attitudes in psychiatry. People of colour were also seen as inferior to white race, and therefore they were often stigmatized for their actions and behaviours, such as masturbation. They were treated differently from the white race, and racist attitudes were prominent where their heritage was used to exploit their sexuality. “As this race exists in Africa, its sexual instincts are peculiarly unrestrained, and although they have learned much moderation, these desires are usually fully satisfied with no feeling of having done wrong. This will account for the fact that the ordinary sexual perversions are seen among precox patients of the colored race much less frequently than among those of the white race7. The use of race to explain the nature of the coloured patients in wards such as the Zomba Lunatic Asylum show that the racism and racial stigmatization that existed in societies in 19th century predominantly existed inside the wards as well, where patients were often more defenceless due to their mental vulnerability.

    Susceptible to Insanity

    The notions of patients of colour as a race different from their European counterpart lead to various theories on the susceptibility of patients of colour to develop certain mental illnesses. The patients of African decent who were diagnosed with “drapetomania”, mental illness unique to black slaves who desired to run away, clearly depict the racism of the 19th century asylums. Any individual who were violent, abusive, lacked control, or was abnormal were able to be institutionalized8. Slaves who desired to run away were seen as abnormal, and this abnormality was seen as a mental illness for the people of African decent, leading them to become institutionalized. African Americans were also seen as susceptible to insanity due to the slave emancipation and the confusion the new found role brought on to ex-slaves9. This thought would continue to early 20th century, where theories continued to appear throughout the 20th century stating that emancipation after the end of the civil war was the cause for the increase in African Americans’ mental illness. These theories were seen and used by legitimate practices by physicians. A.B Evarts, an expert in psychiatry in the early 20th century wrote: “During its years of savagery, the race had learned no lessons in emotional control, and what they attained during their few generations of slavery left them unstable. For this reason we find deterioration in the emotional sphere often an early and a persistent manifestation.”10 Such derogatory terms and attitudes against African Americans inside the wards of the 19th to 20th century illustrate the racial discrimination asylums practiced on their patients. Racial discrimination in the form of looking at patients as a race that was susceptible to black-only illnesses, such as the bogus diagnosis of “drapetomania”, or insanity brought on by confusion in the role of society, clearly depicts racist ideas that played significant role in the experience and outcome of African American patients in the asylums.

    Diagnosis on Black Patients vs. White Patients

    Medical diagnosis of patients in lunatic asylums were often based on the patient’s race, and the clear distinction between diagnosis of white patients and black patients show that racial diagnosis was often practiced inside the asylums. Depression or suicide in the 19th to 20th century was seen to be linked to intellect, where white patients were seen to be more susceptible while the blacks not so much due to their supposed intellectual inferiority11. Melancholia was a mental disorder that practicing doctors Greenless and Conry of Valkenberg Asylum believed were results of stress on a highly developed nervous system, and how mental illness was diagnosed to patients based on their racial background is demonstrated by the reports of the Valkenberg Asylum. Between1872-1888 in the Valkenberg Asylum, there were 20 out of 212 white male patients who were diagnosed with melancholia, while none of the 114 coloured male patients were diagnosed with the specific disorder12. The statistics show that a patient’s medical diagnosis according to race was a regularly practiced in lunatic asylums of the 19th century. In a different asylum, two doctors Watson and Shelly would observe in the Zomba Lunatic Asylum regarding the frequency of a patient developing schizophrenic neuroses, “The fact that the Nyasa and South African natives are more akin in origin, while the Kenya people have a much greater admixture of Hamitic blood, may be a possible ex-planation.”13 The use of race in explaining a patient’s insanity reveals how crucial race was in diagnosing a patient inside the asylums of the past.

    An interesting way in which race played a part in a patient’s diagnosis is illustrated by patient Johanna W. in 1904. As a half European, half black 23 year old women, she was admitted to Valkenberg Asylum when they were exclusively receiving white patients and was diagnosed with acute melancholia, which was a diagnosis given to predominately white patients14. Probably due to her racial background as a half-African she was transferred to a different hospital, but when she came back to Valkenberg Asylum later when the hospital began accepting black patients as well as white patients, and were familiarizing themselves with black mental illnesses, she was diagnosed with “dementia paranoids”, which was a diagnosis given to predominately black patients15. The dual background heritage that Johanna had, being both white and black, must have proven to be a source of confusion for the asylum. The confusion is illustrated through the back and forth diagnosis the hospital gave to Johanna, first ascribing her with a “white” illness than later labelling her as a black where her diagnosis changed. Johanna represents the changing diagnosis asylums often prescribed to their patients strictly based on race as a factor, and how the treatment plans for patients of African decent differed from patients of European decent.

    Segregation in the Asylums

    Lunatic asylums of the 19th to early 20th century emphasized the institution as a family where it was a home, or a fostering environment for the patients. This was often not the case, where segregation and poor conditions of the facilities were prominent. Throughout the 19th century, the colonial psychiatry ideals on how to treat mentally ill patients were developed, where the segregation of the blacks and whites were implemented in asylums such as Robben Island Lunatic Asylums16. Prior to 1976, the Robben Island Aslyum had a segregated portion of the ward where lower class black patients were located, named “kraal”, meaning “animal pen” in Dutch17. This was a name used by staff and patients alike, and illustrates the extreme racial slurs and attitudes that existed inside the wards when segregation accompanied the institutions. The Medical Committee of 1854 regarding the Robben Island Lunatic Aslyum stated “white inmates whether insane or lepers, should be kept separate from the blacks, as the intermixing of the two classes without distinction is undesireable.”18 Racial attitudes against black patients and the need to segregate asylums were not a unique phenomenon. In the Zomba Lunatic Asylum segregation was practiced as well, where the asylum experienced funding issues which delayed the arrival of the Medical Department to take over the facilities until the 195119. Consequently the segregated portion of the ward where black patients resided were in extremely poor conditions, where patients were observed to be underfed, malnourished by minimally trained professionals, as reported by a medical examiner20. The poor conditions of the wards, especially for the segregated black patients are reported in other institutions as well. For St. Elizabeth Hospital in Washington, segregation meant inferior facilities in the section of the ward intended to house the African Americans. When desegregation occurred in America, the hospital instituted transfer of white patients into the section originally intended for black patients, and the complaints that the white patients expressed regarding the poor physical condition inside the chamber illustrate the inadequacies of the asylums in treatment towards African American patients21.

    Segregation demonstrates not only the dissimilar and negative treatment patients of African decent experienced, but also symbolize the restriction these patients experienced. The South Carolina Mental Hospital was originally intended to institutionalize only African American slaves who suffered insanity, but later by 1860 when there were too many patients to house they often turned away African Americans and first priority went to housing the white Americans22. The African-Americans who were not instituted would often be left at the hands of the white owners, who often dealt with their slaves in their own independent ways23. In contrast, the Valkenberg Asylum in Cape Colony was originally intended to institutionally only the “better class citizens”, meaning Europeans-only24. Valkenberg Asylum would later have to accept patients of African decent as well when desegregation occurred. These institutions and their intent to house only one kind of race illustrates the need the people back then felt to segregate their patients, and the negative impact it has left on black patients, such as poor facilities or being deprived of any treatment at all.


    As Meagan Vaughn mentions in her article, patients in asylums were victims of humanitarianism25. Patients of African decent who were institutionalized in 19th to 20th century lunatic asylums were victimized by the intentions of the wards. Despite the intentions by experts and thinkers of the time who embraced the ideals of Enlightenment and tried to use incarceration as a solution to help and cure the sick, which is arguably a respectable effort, it nevertheless failed in many ways. Treating patients as a race rather than as individuals is one of many failings of the lunatic asylums of the past. The exclusion of race in the description of patients in official documents, where social class and gender were used as primary factors in evaluating a patient illustrates the awareness of the institutions to treat patients accordingly; however race would inevitably a significant part in how a patient was treated. Patients of African decent were often stigmatized and seen to be susceptible to certain mental illnesses, which restricted their treatment in the asylums. They were seen as inferior next to the white European patient, and consequently their diagnosis and treatment altered strictly based on ethnicity. They were segregated and had to endure poor conditions inside the facilities of the asylums, as well as the racist attitudes and medical treatments that accompanied the segregation. The patients of lunatic asylums were indeed victims of the institutions, where the sense of righteousness masked the failings of the institutions, such as treating patients of African decent as a collective race. They were dehumanized due to their ethnicity, and their experience in the lunatic asylums and mental hospitals of the past symbolize the failings in the past practices of incarceration.

    1. Carol Berkenkotter, and Christina Hanganu-Bresch, “Occult Genres and Certification of Madness in a 19th-Century Lunatic Asylum.” Written Communication 28, no. 2. (2011): 227-228.

    2. Angela McCarthy, “Ethnicity, Migration, and Lunatic Asylum in Early Twentieth Century Auckland, New Zealand.” Social History of Medicine. 21, no. 1 (2010): 49.

    3. Harriet J. Deacon. “Madness, Race, and Moral Treatment: Robben Island Lunatic Asylum, Cape Colony, 1846-1890.” History of Psychiatry. 7, no.26 (1996): 294.

    4. Megan Vaughn. “Idioms of Madness: Zomba Lunatic Asylum, Nyasaland, in the Colonial Period.” Journal of African Studies. 9, no. 2 (1983): 227.

    5. Ibid, 228.

    6. Ana Maria Raimundo Oda, et al. “Some Origins of Cross-Cultural Psychiatry.” History of Psychiatry. 16, no. 2 (2005): 163.

    7. Matthew Gambino. “These Strangers Within Our Gates: Race, Psychiatry and Mental Illness Among Black Americans at St. Elizabeth Hospital in Washington, DC 1900-40.” History of Psychiatry. 16, no 2 (2205): 392.

    8. Harvey G. Simmons. “Insanity in the 1930’s’ and ‘Deinstitutionalization in a Vacuum’” Unbalanced: Mental Health Policy in Ontario, 1930-1989. Pp 23.

    9. Deacon, “Madness, Race, and Moral Treatment”, 287.

    10. Gambino, “These Strangers in Our Gates”, 391.

    11. Ibid, 392.

    12. Swartz. “Chaning Diagnoses in Valkenberg Aylum, Cape Colony, 1891-1920: a Longitudinal View.” History of Psychiatry. 6 (1995): 441.

    13. Vaughn, “Idioms of Madness”, 230.

    14. Swartz, “Changing Diagnoses in Valkenberg Asylum”, 446.

    15. Ibid, 447.

    16. Deacon, “Madness, Race, and Moral Treatment”, 289.

    17. Ibid, 292.

    18. Ibid, 291.

    19. Vaughn, “Idioms of Madness”, 224.

    20. Ibid, 224.

    21. Gambino, “These Strangers Within Our Gates”, 399.

    22. Barbara Bellows. “’Insanity is the Disease of Civilization’: The Founding of the South Carolina Lunatic Asylum.” South Carolina Historical Society. 82, no. 3 (1981): 269.

    23. Ibid, 269.

    24. Swartz, “Changing Diagnoses in Valkenberg Asylum”, 431.

    25. Vaughn, “Idioms of Madness”, 238.