The Peculiar Institution and the Making of Modern Psychiatry, 1840–1880 by Wendy Gonaver (review)

In battling the many-headed hydra of racism, African Americans and other people of color in the United States are not only more likely to experience serious mental health conditions, but also racial bias in the form of misdiagnosis, poor quality of care, neglect, and malpractice. Historical analysis is key to understanding how systemic, institutional, and everyday racism creates and sustains persistent racial disparities in health status and racialized experiences of care, and historical case studies can be effectively deployed to raise awareness and tackle racial bias in medical education and doctor-patient encounters.

To this end, a rich and ever growing body of historical scholarship maps the institutional treatment of the mentally ill in various colonial regimes, including the racist dimensions of psychiatric thought and practice, with especially impressive research focused on Africa, Asia, Australia, and Latin America. Mental health provision in the British West Indies, for example, has received a significant amount attention from historians of health and medicine in recent years, including Rana Hogarth, Margaret Jones, and Leonard Smith, who have examined mental illness in Jamaica at the grim setting of the Kingston Hospital and Asylum.¹ By comparison, the history of mental health care under chattel slavery in the United States and the emergence of psychiatry under this racialized system of violent capitalist exploitation is a relatively underdeveloped topic. A number of new works are emerging, however, including Martin Summers' Madness in the City of Magnificent Intentions, which considers the admission of enslaved patients to St. Elizabeth's Hospital in Washington, D.C., as part of a longer history of race and mental illness in the capital city.² By re-examining the archives of Eastern Lunatic Asylum (ELA), which was located in Williamsburg, Virginia, Wendy Gonaver's book also targets this still sizeable gap in the current literature, and in doing so takes up Summers' earlier appeal in this journal, which urged historians to explore the experiences of black patients in American asylums using race as a "central analytical lens."³

Gonaver builds on a number of earlier histories of the ELA, notably Norman Dain's Disordered Minds and Todd Savitt's celebrated Medicine and Slavery, which featured a key chapter on the ELA with several useful tables that established the scale of the free and enslaved black presence at the institution.⁴ In her account, Gonaver digs deeper in an attempt to explore a wider range of themes and issues related to professional identity, race, religion, and gender at the ELA, in the contexts of chattel slavery, the Civil War, and Reconstruction. The opening chapter focuses on John Minson Galt II's tenure as superintendent of the ELA and his promotion of innovative "moral reforms" at the institution, including the admission of enslaved patients. As a founding member of the Association of Medical Superintendents of American Institutions for the Insane (AMSAII), Galt fashioned his reputation as an expert on black mental health, producing a special report for the Association on "Asylums for Colored Persons." Contrary to his own daily experiences, in this report Galt advanced a classic Virginian paternalistic vision of slavery, of a system that provided for all basic needs and under which the enslaved were relieved from life's anxieties, less susceptible to mental illness than free blacks and whites, and recovered more rapidly if so afflicted. Physician-enslavers like Galt used such perverse claims and racist stereotypes to undergird proslavery arguments, advance professional agendas, and flatter the prospective clients of their facilities (pp. 28–35).

In chapter 2, the book's standout case study, Gonaver battles the challenges of a fragmented archive and goes beyond previous accounts, by providing a detailed, nuanced—and often highly speculative—consideration of the experiences of more than thirty of the ELA's enslaved attendants. Despite the ubiquitous racism; suffering the worst accommodation; being tasked with the dirtiest, most...