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This essay examines the case history of “Mary Roberts,” an African American woman committed to Georgia’s State Sanitarium in 1911. Her medical record in the context of other case files from the sanitarium provides an important view into the creation of the modern psychiatric subject at a liminal moment for individual patients, state institutions, and transatlantic psychiatric modernity. What is on view in these doctor–patient jousts is what Ranjana Khanna calls the “psychical strife of postcolonial modernity,” and what is at stake is a deeper understanding of the thoroughly raced nature of this psychiatric strife in the slave and postslave culture of the US South. In Mary Roberts’s case, those diagnosing her condition confuse the cultural practices she used for healing with symptoms of her trauma in ways that prioritized biological theories of degeneration over a public health crisis in Georgia.