No Medical Justification: Segregation and Civil Rights in Alabama’s Psychiatric Hospitals, 1952–1972

In October 1963, President John F. Kennedy signed into law the Mental Retardation and Community Mental Health Centers Construction Act (also known as the Community Mental Health Act, or CMHA), which required states to downsize their existing, overcrowded psychiatric hospitals and offered new federal funds for the construction of community-based centers. To qualify, each state was required to submit a Comprehensive Mental Health Plan. The author of the Alabama plan, the newly hired state health officer Dr. Ira Lee Myers, made a number of frank admissions. “The anti-federalism, the crippling preoccupation with race, the defensiveness inflamed by defeat, poverty and resentment of the efforts to change the people’s value system,” he wrote, “have flared again.” In addition to the baleful influence of those he called “anti–mental health extremists,” Myers claimed that “[t]hese attitudes have not only slowed our state’s progress in the quantity and quality of mental health services, training and research, but have cast a shadow over the planning process itself. Reluctance to accept federal funds and resistance to the concept of planning had to be overcome before the actual job of organizing to plan and study could begin.”¹

At the time of the plan’s formulation, Alabama operated racially segregated health facilities, but with the passage of the Civil Rights Act in 1964, the state faced increasing pressure to desegregate. Rather than actively pursue integration, which was also necessary to qualify for new construction funds, Alabama took the federal government to court over what it claimed was its right to maintain separate facilities for Black and white psychiatric patients.² The case was overseen in federal district court by Judge Frank M. Johnson Jr., a fierce upholder of civil rights law in Alabama, despite the opposition of Governor George Wallace and others, and an exemplar of the power of federal reach and of presidential appointments in undermining segregation in the states.³ On February 11, 1969, Johnson handed down a decision in answer to “a rather straightforward problem”: racial segregation in the state’s psychiatric hospitals was illegal and unconstitutional.⁴

This article examines the struggles that culminated in Johnson’s final decision in 1969. In the fight to maintain segregated psychiatric facilities, southern segregationists employed many of the same arguments used in their fight to maintain segregated schools: the idea that the federal government should stay out of state affairs; the belief that racial unrest was the result of northern outside agitators; and the claim that African American culture was inherently deprived or destructive.⁵ Yet when it came to desegregating medical facilities, southern segregation-ists also benefited from latent racist assumptions and ideas that had long held sway in modern American medicine and psychiatry. Since the late eighteenth century, American medical practitioners had been constructing definitions of difference between white and Black bodies that positioned African Americans as inherently lacking in intelligence and emotional complexity.⁶ Racist ideas about Black deviance and the so-called childlike psyche of African Americans were regularly employed to justify disparities both in accommodations and in treatment and were central to the foundation of America’s psychiatric hospitals.⁷ For the white public, these ideas found expression in fears of physical contact and miscegenation, complicated by the intimacy of medical settings. In such spaces, bodies were necessarily vulnerable and exposed, and the need for care meant that segregation could not always be so neatly maintained.⁸

Activists seeking to end segregation in Alabama’s psychiatric facilities thus needed to challenge not only the racist ideas prominent among white Alabamians but also the latent racism of psychiatric thinking itself. The history of the struggle for integration in Alabama’s psychiatric facilities reveals the complex ways that local communities related to these institutions as places of both employment and medical care and situates such institutions within larger debates about segregation that raged after the passing of the Civil Rights Act. Alabama’s politicians and bureaucrats were willing to use even the mentally ill for electoral gain and...