Mab segrest is Professor Emeritus of Gender and Women’s Studies at Connecticut College and the author of Administrations of Lunacy: Racism and the Haunting of American Psychiatry at the Milledgeville Asylum, and Memoir of a Race Traitor, both from the New Press. A long time activist in social justice movements and a past fellow at the National Humanities Center, she lives in Durham, North Carolina.

The transcript below has been edited for length and clarity. Listen to the audio of the interview here.

Leah Harris: You have written such a sweeping, stunning, anti-racist account of asylum history. Tell us about some of the personal and political motivations that you have for writing this book.

Mab Segrest: I’d love to do that, but thank you very much first for thinking it’s a sweeping, stunning account because it took me a long time to do. I really was determined to have a narrative that could carry along all the details that I had found in the people and their stories, in a way that was a sweeping history. At some point, I realized that the story of the Georgia Asylum was the story of the South, which is such an epic story of white supremacy with a revolution and a counter-revolution every couple of decades.  The story of the South is also the story of “America” with an acute lens of race. People are telling me that I have done that. I’m really happy about that because that was a necessary thing to do.

In terms of intertwined personal and political motivations, first was my continuing personal and political preoccupation with white supremacy, having been born in Alabama in 1949 and grown up in a conservative white family in the midst of a civil rights revolution by Black people.

I remember being very confused about my culture and my family, as it was contradicted by the forces that I saw sometimes in my front yard and on the steps of my church and in my school. [It was a Black revolution] that seemed to be surfacing the violence in the culture, and that in a way that made white people have to think about it. At [ages] 13, 14, 15, I think I was really primed to try to be that observer. [Mine] was of delayed action in sorting it through, but I really have been sorting it through for the rest of my life.

A white woman with short blonde hair and glasses wearing a denim jacket.
Mab Segrest. Source: Laura Flanders.

So that’s one of the things I brought into it: looking at racism with its complications of misogyny, homophobia, heterosexism, sex and gender systems, capitalism—all those forces and vectors. In what was my most notable book, Memoir of a Race Traitor, I talked about the relationship between the intimate and the historic, and asked, “what therapist would tell us to read history?” [In that book] I had tried to combine my narratives of anti-Klan work with memories of growing up as a child in Alabama and reflections on my family.

So I turned from the question of the “therapist telling us to read history” to the history of therapy or psychiatry and a kind of meta-discourse on these questions. [In writing Administrations of Lunacy] I also moved away from Alabama, and I moved away from a first-person narrative, to tell a larger story in which I was mainly located as the voice and the analysis, [not the main character]. So that was a huge shift for me. It was challenging, but I was very excited by having to be on that steep learning curve.

In addition to this childhood preoccupation, use of family material is a point of departure. My great-grandfather on my dad’s side had died in Bryce’s Hospital, which was the state hospital in Alabama. And it was a family secret until my aunt told me in my thirties. She said it explained all of our family issues. In about 1901, he was seeing people shooting at him from trees. And then he started to shoot back, and his family felt too threatened by that. So they sent him off to the state hospital, and he died six months later of a skin infection. She felt like his having been sent to the “loony bin,” as she said, really shaped her and my father’s childhood with the kind of shame that they had a “crazy person” in the family. I was very fascinated by that, too.

Southern literature had always been my refuge and source of information when I was in college, to try and understand the South more. And the asylum was in Carson McCullers. It was in Flannery O’Connor, who wrote from Milledgeville. Most of her more contentious and, some would say, grotesque characters I came to see had just marched straight out of the asylum into her pages.

Carson McCullers, photographed by Carl Van Vechten, 1959. Source: Wikimedia Commons.

So those Southern writers, many of whom were queer, “got” the politics of the asylum before social scientists did, before historians did, before Foucault did, and so forth. These Southern writers really queued me up for the Milledgeville story. McCullers, for instance, in Member of the Wedding: her little gender-bending 13-year-old white child was warned that she would be dragged off to Milledgeville if she didn’t be careful. Or in Tennessee Williams, at the end of A Streetcar Named Desire, where Blanche says, “I’ve always relied on the kindness of strangers,” as she’s taken off to Mississippi State Hospital because she was raped by her brother-in-law.

When I started looking into the Georgia State Hospital, partly inspired by McCullers, and curious to see what was going on, with a few Google searches over an hour, I found out it had been the largest state hospital in the world in the 1940s and 1950s when McCullers was writing about it. It had the largest graveyard of disabled people, and was considered, as I read into psychiatric history, “American asylum psychiatry writ large.”

And just a devastating, fascinating story. I went and started looking at the archives, and I spent the next ten years doing that. As I looked around, there was only one other history of a Southern asylum which asked the question of race, Peter McCandless’s 1996 book Moonlight, Magnolias, and Madness, but really didn’t delve into it. So I decided that rather than write an article on McCullers, I really wanted to write that history. That drew me into it, and it kept me there for much longer than I had intended, partly because of the complexity of understanding the material, gathering the material, and then writing it.

Harris: How does an explicit focus on white supremacy, looking at psychiatry through the lens of race and racism, challenge some of the existing asylum histories that, as you say in the book, have been primarily narrated by white men?

Segrest: An explicit anti-racist focus picks up the narrative and puts it down in a totally different place. Which is completely what I’m trying to do: to reframe the narrative of psychiatry, of asylum psychiatry, which is where psychiatry started, in these state hospitals in Europe and in the United States. Enlightenment philosophers and practitioners and doctors started to see that if they treated people well in these custodial institutions, if they fed them, if they got them away from home, if they let them rebalance, they could make the environment curative. It was called “moral therapy.” It started in Europe and happened in the United States, too.

But the moral therapy goes very south. I was tracing the Southern story, too. Once we turn South to examine how the Southern “exception” is the national narrative, much can be told.

A black and white photograph from the 19th century.
Superintendent Dr. Theophilus O. Powell (R), 1897. Source: Georgia Archives.

The story of the Milledgeville asylum was compelling to me. To tell the story of psychiatry from a slave-drenched location like Georgia, starting in 1842, just as abolition was heating up, you will get a very different view. You tell a very different narrative. In Southern history, you have to be aware that race is so formative; that the conquest of Indigenous people was brutal as was a slave system; and the rebellion against it was heroic and still going on. I wanted to overlay the history of psychiatry and particular asylums, how they were being constructed, onto the sweep of southern and US history.  [That would shift particular studies]  which were usually fairly ahistorical in terms of some of the larger sweeps of Southern history, [the kind of perspective that’s]  emerged in American Studies over the past 50 years.

I wanted to have that history of asylum and I wanted to overlay it with the history of the South, of settler colonialism, how folks from England came here and decided to stay, and then had a revolution to take over control of the continent and its conquest. That settler colonial process, overlaid with psychiatry, gave a different kind of narrative. I think it’s a very different tale.

Some of the men writing psychiatric history weren’t attentive to questions of race or gender. They were looking at institutional histories, their role in the history of medicine, how psychiatry emerged from that. But there’s another set of historians who are “anti-psychiatric.” I was asked when I was at the National Humanities Center by a colleague, “Is your book anti-psychiatric?”

It took me a day and then I came back and I said, “No, it’s anti-racist.” There’s many things within psychiatry; I find psychiatrists doing both execrable and really commendable things within this history. But if you ask, “How is it anti-racist?” then you start to ask a different set of questions. It requires a different methodology, a different set of archives, and secondary sources. And it comes up with a different set of conclusions.

Harris: In addition to Southern literature and some of the other sources that you’ve mentioned, where were you able to glean some of the answers you were looking for in this anti-racist history of the Southern asylum?

Segrest: Well, I went to the places that historians generally go: the state archives, the local archives, interviews, newspaper accounts, and so forth. I had never done this kind of archival research before; I found it fascinating. There’s this whole experience of the archives, where you just enter imaginatively into a different world. It’s a detective story and it’s a treasure hunt. You find this piece and that piece, and you’re quilting together stories.

As a literary critic formerly, you just have a novel and then you analyze it. But with this material, you have to find the story, find the pieces of it, stitch them together in such a way that suggests a pattern, and then frame them. I spent 15 years on this book because it was such a complicated story, and I had set myself to do an ambitious task. So the Georgia State Archives was the first place I went. I looked up “Georgia Asylum” or “Central State Hospital” and it spit out a bunch of stuff, including annual reports. Not all of them, but lots of them. I copied as many as I could.

They also had asylum ledgers, which I had to get permission to use from the Secretary of State. I explained how my research was valuable to the people of Georgia, that I would respect confidentiality, and that I was a legitimate scholar; I was glad that they agreed with all those things.

And then there were also a set of case histories. From 1909 to 1924, these case histories had both the context of the medical exams but also the entry interviews with patients. And I was really electrified by the time I got to this material, because so much more of it had been just the ledgers talking about the patients, and it was very hard to get a patient’s voice there.

But all of a sudden here, in transcribed, typed interviews, you had this give-and-take. You had a range of Georgians, poor mostly, Black and white, men and women, answering questions like, “Are you happy? Are you sad?” Most of them were sadto be in this institution. And the thing that made them happy was Jesus. Or, “Do you see visions? Do you talk to God?” Well, a lot of them talked to God. It’s called prayer, and that’s what was getting them through.

It was fascinating to me to see these new medical diagnoses being used to interrogate these folks. And then how it was interpreted in the staff meetings, which were also transcribed and typed. Those patient voices end the book; how they are battling sometimes with their doctors, who don’t really understand so much what they’re doing, and what that suggests about modernity and psychiatry.

There was also the Atlanta Journal and Constitution, which has been digitalized from 1868 to 1945. So when I was working in the Emory Library in Atlanta, I was able to type in “Milledgeville” and “asylum,” and the computer would just spit out all of these fascinating stories, because it was a hot topic for Georgians by the turn of the century. A very sensational topic, as it is today, and lots of folks had lots of things to say about it. That really filled in a lot of the details. And then one of the librarians suggested I look at Supreme Court cases. I got another level of narratives, as various aspects were getting adjudicated.

Then I talked to people all over Georgia who were fascinated by this story, because their families in Georgia, like mine in Alabama, had been profoundly impacted. By the fifties and sixties, it’s fair to say that institutions like these—certainly in Georgia—reached into almost every kinship network in the state. People knew what it was. They knew it was a terrible place to go. They were afraid to get sent there. And if you threatened them with being dragged off to Milledgeville, they knew they didn’t want to do that. They had better shape up. So all of those sources were a composite of where the book comes from.

Harris: Obviously, you’re covering a tremendous amount of ground in this book, but I wonder if we can start with the traumatic impact of the Civil War. In your estimation and study, how did the war’s impact land on both white and Black people in Georgia at that time?

Segrest: That’s a good place to start, but let me back up a little bit. The asylum was founded in 1842 and it closed down in 2010, so it’s 170 years of Southern insanity. (I do consider “Southern insanity” to be somewhat of a redundancy, given the culture.) One of the questions I was asking myself going in is, “How can a culture that permitted and even promoted lynching decide who is sane and who is not?” How does that happen? I was trying to figure that out, going back as far as I could, and also forward.

In the earliest 25 years, it was only white people who were committed to the asylum, because Black people were on the plantations. And the plantation could “handle” every damn thing—quite brutally, with force when it needed to. So white people were there until 1867, and then Black people joined them from Freedmen’s Bureau hospitals.

A black and white image of an asylum with a few trees in front.
African-American Building, 1894. Source: Georgia Archives.

The Civil War then was this pivot moment in U.S. history, certainly in Southern history, and in Georgia history. A lot of the Civil War has been told, for a century at least, from [the perspective of] the generals and the battles; a very military history-obsessed version. I certainly grew up with that.

Robert E. Lee was a saint in Alabama for segregated white children. Jeb Stewart, all these guys, we knew their names. We knew what they did. We knew what their horses’ names were. In fact, Robert E. Lee’s horse was named “Traveler.” You may not know that, but we did.

Only recently has history turned to what happened to the soldiers. And African-American history has provided such a rich tapestry of what happened to enslaved people, and such a model for how to tell Southern history, including the histories of slavery, emancipation, Jim Crow, and so forth. I’d been very guided by that, especially W.E.B. Dubois, a brilliant, brilliant man.

So when you get to the Civil War, only recently have these psychiatric aspects been looked at; they reveal what battle and war do to people. These recent histories focus on the regular soldier, and what happened to that person, that man—mostly, that white man. Although Black men were fighting in the Union army, too. They were determined to fight for the freedom they’d wanted for 300 years.

And of course, slavery had always been traumatic. The Civil War added both an extra layer of hardship for African-Americans, but also gave this huge promise of freedom, especially as Northern troops took over more and more Southern territory. And the Black people knew it was coming. The South basically got its butt kicked in the Civil War, it got really seriously defeated, and was almost about to emancipate slaves in order to get more Confederate troops, which might not have worked.

And then Appomattox [happened], and the war was ended. But African-Americans knew as the war ground to what was going to be an obvious end, that they could soon fight for their freedom openly, and they would do that. So it’s a complicated story, I think, for Black people.

For white people in the South and the North, the Civil War caused more casualties than all the other wars in American history put together. And this is because it was civil war, so both sides get counted. But at 600,000 to 800,000 people who died, it was a carnage of world-historical proportions. Historians have said with the death rate six times that of World War II; in fact, three times more Confederate men died than Unions, because it was fought on the grounds of the South.

One in five Southern men of military age didn’t survive the Civil War. General Sherman’s total warfare in the South was made on civilians as well. His “March to the Sea” was scorched earth; just devastating the South as a way to break both the military and the civilian resistance, which he did.

Some of these historians then talk about what actually happened to these soldiers. Southern soldiers were having to go on forced marches over graveled roads. Many of them had no boots. By that time they were exhausted. They go into battle, saw this pandemonium, people being blown to death around them. They’re already exhausted. And then they’d sometimes just collapse. When the battle is over, they wake up, their adrenaline’s gone, and now they have to bury all their dead friends around them. It was something that would break both the mind and the body. These historians trace the way in which it breaks the body first and then it breaks the mind.

The prevailing explanation of “insanity,” madness, during the Civil War, was “heredity.” So if someone experienced a psychic break in this environment, it was considered first that they had “bad heredity.” We might call it “bad genes” later, but somehow their family stock was “deficient.” And if you had this, then you could break in these bad circumstances, whereas somebody with better “heredity” wouldn’t break. By World War II, the psychiatrists said, “No, some situations will break any person.” But the Civil War folks didn’t have that, so if they broke down they could be considered a coward; they could be sent to the front of the lines, and so forth, and that meant death.

I was fascinated with the Civil War because it was a chance to look at trauma and psychic health in the midst of one of the most intense traumas, on the battlefield. I traveled through these different periods of Southern history, sometimes with the soldiers, sometimes with the women at home, sometimes with the enslaved Africans, to see what happened to them, how it ended up in psychiatric records. And I found records of it during the war and immediately after. But they really dropped out by the turn of the century, by about the time when my great-grandfather started shooting at people he thought were shooting at him from trees. And there was really overwritten of that history, this theory of what we would call “mental illness” today, “lunacy” being caused by “degenerate populations.” Not by war, not by historical trauma, not by lynching, not by the convict lease system for Black people; not by all these stresses of history that kick off certain kinds of biological manifestations.

They weren’t caused by that. And because the psychiatric records didn’t really carry over the experiences of the war, it was possible to reconstruct these narratives about vulnerable populations—men, women, immigrants, Black people, poor people—into the Eugenics movement.

There’s this battle across psychiatry in the 19th and 20th centuries between those doctors and superintendents who see a mainly biomedical model: the body itself, and narratives about it and its experiences, but really outside of history. And there are those who want to look at what happens to the body and the mind in the context of what was called “socio-cultural variation” by one set of psychologists protesting the latest DSM. So it’s this “psychosocial variation,” this environment, this context, this history where the bodies and the mind are also located. The mind is part of the body, and the body’s part of an environment, and it’s part of history. I am arguing as heartily as I can that you have to really understand that whole history to see what happens to the body-mind in this period, and in this country.

Harris: And that is, I think, one of the many correctives that you’re able to offer in this book.

Segrest: I tried to show, too, that what happens to Black people affects white people. By the turn of the 20th century, the elites who are promulgating Eugenics hated poor white people, too. They wanted elite, “fit” white families like theirs, who were starting to make massive fortunes—the robber barons—and control commerce in the 20th century. Those people should be reproducing, and all these other folks are just “problems” and “failures.” And so, what do we do with them if they are inherently defective, if they’re inherently degenerative as a people—not because all these different things have happened to them, and they’ve been on the downside of this history that some people have been on the upside of. Well, we need to figure out how they don’t reproduce again. Surgical sterilization became the solution to that in the 1930s, but it started about 1900 at the Georgia Sanitarium.

Harris: How did Kraepelinian thought, the racial hygiene movement, and the Eugenics movement influence how asylum care was practiced in Georgia?

Segrest: Emil Kraepelin was a doctor working in the German system of clinics and research universities and framed mental illness as a set of diagnostic categories. Other professionals that he was in conversation with in Germany were doing similar things. But his set of categories elevated what he called schizophrenia, “dementia praecox,” and manic depression. The two major psychoses, as we call them today, became codified in textbooks that he wrote, and rewrote, and rewrote, and then they came over to this country. They emerged at a period where this moral therapy that the asylum had been imagined to bring about was breaking down in the face of overpopulation. The moral therapy would have been great with 300 or 400 people, or so its practitioners thought. But by the turn of the century, you have 3,000.

You have many, many more people being sent to these public institutions by folks at home, or their counties, whatever the administrative unit was, than could ever be handled in any kind of moral therapy way. The main thing that Kraepelin did was to categorize and classify what he saw as the symptoms into illnesses that had certain trajectories, and then write them up. So manic depression, schizophrenia came to the fore. One issue, though, was that in the 19th century, at the end of the 19th century, they moved into a period of therapeutic pessimism, because there was really no cure that they had found. So the main thing they could do was categorize and institutionalize. Kraepelin’s categories came out of that as well. So when they come to Georgia, you have had before 1910 in the annual reports, “cause of insanity” as the question. It would be “fell off a horse;” “had a fever;” women had various menstrual difficulties; “ate a peach kernel” (an idiosyncratic one); “lost a job;” “wife or husband died.” The kind of compilations of something that might’ve happened medically; something that was in the environment. My favorite one in 1908 was “drank too much Coca-Cola,” which I have had to be careful about myself.

Black and white photo of a large-imposing 19th century asylum.
Milledgeville State Hospital, Central Building, 1937. Source: Historic American Buildings Survey.

You have this shift from such a set of categories to “is it manic depressive, is it schizophrenic?” And you have these doctors in these case histories trying to struggle between the two, and half the time not deciding, “Well, maybe it’s this,” “Maybe it’s the other.” They really didn’t have to decide in those case histories that actually contained the summary of their decisions, their verbatim conversations. They didn’t have to decide, because there was no treatment anyway.

People would be in there for their lifetime sometimes. Sometimes they’d be sent back home, but a lot of people were there for the lifetime, with no treatment, and with a diagnostic system that mainly just justified the reason that they were committed. To trace that shift into a more scientific nomenclature at a time where the asylum was very much turning increasingly into not only just a custodial, but a very punitive, institution that was starting to terrify everybody in the state of Georgia or across these States. Nobody wanted to have to be sent there, because they had very bad reputations. And so to follow those ideas through the various Diagnostic and Statistical Manuals, up until DSM-5, was part of my process.

[Of] the early DSMs, the first two were heavily influenced by psychoanalysis, which is what Freudian doctors brought to the United States, had experimented with in Europe, and was dominant in American psychiatry for a couple of decades. But by the 1970s [with] DSM-III, there was a turn back to biological psychiatry—to how the brain was constituted, how it worked, how various diseases and symptoms might occur from various kinds of brain functions that were happening in the body. But if that was mainly this biomedical model that wasn’t embedded in history and “socio-cultural variation,” then [this kind of thinking] could have the same dangers and damages as it had in the 19th century [that led quickly to eugenics].

So some of that was struggled out as I understand it, and I’ve seen in the psychiatric records in the profession into the 21st century this tension between the biomedical model outside of history or socio-cultural variation, and the model that takes into account community, environment, history in terms of a person’s mental and psychic states. This tension played through two centuries, and it played out through the DSMs, too.

I came into a realization of that discussion when a colleague in [psychology] gave me an “Open Letter to DSM-5,” from around 2011. And it’s from humanistic psychologists across all of these professions who were protesting DSM-5, as many people did, including the editor of DSM-IV. Because of these issues [with the biomedical model]—there was a lower threshold of diagnoses that created false epidemics, that targeted vulnerable populations. There was too much reliance just on [the] biomedical model and not on “socio-cultural variation” [which I call “history”]; there was a return to “deviance.” There were all of these things that had marked the worst in psychiatry [for two centuries], and been battled within psychiatry for more community-based, more historically-nuanced [approaches]. What the letter to DSM-5 called for was a rethinking of psychiatry and human suffering basically from the ground up. I was galvanized by the depth of this appeal.

I was very encouraged to see such a broad call for rethinking because it really was tracking onto what I was finding in these archives. If you want to rethink psychiatry from the ground up, then here’s some ground to think of it from: this ground in Georgia that I’ve been tracing could give some insight into what does happen when you look at human variation in history and culture, and what happens when you don’t, as a kind of object lesson.

As I’ve gone along, I feel like I have lined up with professionals in the field who are already fighting these battles. I feel more confident that archives and the voices I have found within Georgia have a broader story to tell to the nation from inside an asylum, an iconic asylum, the largest asylum in various places, a notorious asylum, an asylum from the depths of white supremacyabout what can happen when these balances go awry.

Harris: Such an ongoing lesson for us all that continues to play out. Moving very rapidly through the 20th century, one of the historical markers that you touch on in this book is the 1999 Olmstead vs. LC decision, a landmark a Supreme court decision. You make quite a definitive statement in your book about Olmstead, that it sounded the “beginning of the end” of the institution that you document throughout. Tell us a little bit more about Olmstead, why it’s so significant and continues to be so significant in this debate?

Segrest: Olmstead came out of Georgia. It came out of Atlanta Legal Aid and the very brave and valiant advocacy by Lois Curtis and Elaine Wilson, two Georgia women who had spent their lives in and out of Georgia psychiatric facilities, and maybe sometimes the jails. Lois called Atlanta Legal Aid for help. And the lawyers, led by Sue Jamieson, applied the new Americans with Disabilities Act to the situation that was rampant across Georgia state psychiatric facilities at that point, to say that it was against patients’ rights to be involuntarily committed and held against their will. That the segregation and congregation of disabled people, both cognitively disabled people and people believed to be “mentally ill,” to take them out of the communities was a violation of their rights. And that they deserved treatment as near to home, if not in their homes, as was feasible by the budget, which is always a big question.

It was the victory of a set of abolitionists who had been working to abolish the asylum in its worst kind of manifestations for 50 or more years. It was a high watermark of rights for disabled people, rights for “mentally ill people,” rights for cognitively disabled people.

Moonlit statue of an angel reaching for the moon.
Angel statue at Milledgeville, erected by members of the Georgia Consumer Council, some of them former patients, in 1997. Source: Georgia Archives.
Harris: Given what you know about Milledgeville and the history of asylum care in general, what do you see as the uses and the abuses of the history of trans-institutionalization, of jails and prisons taking the place of mental institutions? This narrative can sometimes be used to justify the expansion of involuntary care or even a re-incentivizing of institutional care, calls to literally “rebuild the asylum.” What are your thoughts?

Segrest: First let me say I’m not a professional in this, and I have never been myself committed to an asylum. I’ve never been diagnosed with a psychiatric category. So I’m writing this, not having had that lived experience and I very much respect the point of view of the people who have. I’ve tried to incorporate that as much as I could in my narrative.

There was a process of deinstitutionalization that happened in the 1950s and 1960s, and turned out, I think, tragically as tragic as the asylums had turned out by mid-century. It was motivated because the asylums themselves had become derelict places. The end of World War II opened up concentration camps in Europe and showed their terrible effects, but people could make a parallel to what had happened in these state hospitals, and the people in them, when they had been constrained that way. People were also somewhat more attuned to the dangers of ideologies against disability, because Hitler’s first set of targets were disabled people. His Aktion T-4 Program in 1939 took all the lists that the eugenics folks had assembled of folks in state hospitals, and the various forms of disability and mental illness and asylums—and then took them to the gas chambers.

That was the first time that had been done: the use of gas chambers by Nazis. It was the first part of Hitler’s extermination; it was the only one that had gotten a lot of pushback from German people. But a lot of disabled people got killed in those institutions. All of that history finally came out in the wash post-World War II: People knew that eugenics had not been a good thing, that these institutions in Germany with terrible things, and there were certain kind of reverberations about how we treated, number one, both Black people in the South if we’re claiming to be a democracy, but also “the mentally ill.” If we look at the history across these institutions, they are really what one journalist [Albert Deustch] called the “shame of the States.”

And this interior story of the institutions in the United States had happened because there were 3,000 conscientious objectors who didn’t want to go to World War II and went into state mental hospitals, many of them working as orderlies in the most so-called “menial” positions, with the most contact with patients. And they really revolutionized this work, because they brought kindness and spiritual practices and political beliefs and consciousness into it. [They] began to reshape understandings of mental illness. to shape public educational programs, and also to document the abuses in these institutions.

So by the time the war was over, you had this internal evidence and you had this climate of human rights. The Universal Declaration of Human Rights is passed in 1948. You had a different climate. People knew that the institutions had failed, and then it seemed that medications had come along. Thorazine was the first one that was purported to be this “miracle drug” by psychiatric journals that had taken a lot of money from drug companies. It turned out not to be quite so miraculous. It turned out to have a lot of side effects.

But before some of that played out, John F. Kennedy, inspired by the new “miracle drugs,” put forth a new vision for mental health that would become deinstitutionalizationgetting people out of these asylums to community care. But he also thought that there should be community health clinics all across the country. So when people came out of these asylums into their communities, they had care there. Their families were helped, they were helped. That was the plan.

Well, many of those community institutions didn’t get off the ground, and many of the ones that did continued not to be funded. So the community care that’s supposed to be there got displaced by the budget cuts that happened under Ronald Reagan, the austerity that cut social programs and fed the military, so that people came home to not enough help. And they ended up in this period of trans-institutionalization, where they bounced around from the hospital and psychiatric clinics to jails, to under bridges, on their relatives’ sofas, or sometimes getting shot in confrontations with police.

That was a tragic situation, and it was made tragic because communities were never given the funds to do the kind of work at home that the state hospital was supposed to have done in a place like Milledgeville or Bryce’s. It was underfunding Health and Human Services and over-funding the police. So how all of that came together, I think, points to a continuing failure of politicians with this point of view to pay for human needs. And when we don’t do that, we get the results.

I think that the call to “return to the asylum” is a huge red flag that this is a resurgence of the most regressive forces in 200, if not 400 years of United States history. Certainly 200 years of psychiatric U.S. history, and enslaved people first came 400 years ago. This is the most regressive set of policies. And we haven’t broken those policies. It’s what African-American scholars call the “afterlives of slavery,” because we haven’t broken white supremacy. It just keeps reinventing itself. So we have the first Reconstruction, the second Reconstruction, now it’s mass incarceration, it’s a new Jim Crow, and we incarcerate more people than any other advanced industrial country. It’s just obscene. We’ve gone from 300,000 prisoners in 1980 to 2.3 million prisoners in 2010.

Rows and rows of metal markers commemmorating unmarked patient graves.
A symbolic representation of the more than 25,000 patients buried in unmarked graves throughout the Central State Hospital grounds. Source: John Kloepper.

When you have that kind of investment in a system of incarceration, a kind of Gulag system, then psychiatric beds kind of got eaten up in that, and the asylum was intimately linked to that. So if you’re going “back to the asylum,” you’re really just keeping it embedded within a prison system, which does not do any person any good. The most eloquent testimony to this is from the National Sheriff’s Association, where individual sheriffs know they are not set up to treat “mentally ill people,” which they find dreadful public policy that is “incomprehensible.” And there’s all sorts of negative repercussions on those people who were “treated” inside jails and prisons, because they’re just not set up for it. Of course they are not.

So how in the hell did we get in this situation? Why is it as tragic sixty years later as it was before they’d been deinstitutionalized? How do we keep ending in a tragedy for this question? You have to think it’s not accidental. There’s a set of really bad ideas like enslaving people, lynching people, sterilizing people. There’s a history of these ideas and we have not broken their hold. We have shifted away from them, we have alternative policies, but we are still in a life-and-death battle over how to constitute our society, what to pay for, what to not; what the role of the state is, how capitalism shapes us. We are in a battle to the death over all of these questions, and the psychiatric piece is up in it.

Harris: Returning to the question that you started off with in your book: “How does a state that conquered Native peoples, innovated and administrated the system of chattel slavery for Africans, encouraged or refuse to stop the atrocities of lynching and developed Jim Crow—how could that state, be it Georgia or the United States, decide who was and was not sane?” As you said, it’s continuing to morph and change. So given all of that, do you think that the state should have that right to decide today?

Segrest: Depends on what state it is. If you’re in a state and a national system that’s promoted all of these things, slavery and Jim Crow, then that state is not going to be very trustworthy. But there’s an opposition movement in there that has fought for abolition, that has passed the 13th, 14th, and 15th  Amendments, that has battled Jim Crow, that has repassed civil rights bills, that continues to struggle in these ways for a more just country. There’s a battle in this country for who actually controls the power of the state. And there are models for a more humane kind of welfare state. Some people would say they make people too “dependent.” But this is a culture [that] is so extreme from that, where people are so vulnerable, they have so few protections from anywhere, anymore.

So what state is it? The state that’s being controlled now over the past three or four years, since the past election? The people in charge of the state now consider it the “deep state” and are trying to dissolve it, so God knows what it leaves us, except vulnerable to everything. Those people? I so don’t trust them; it’s hard to find the words to express how much I don’t.

But there are other folks who haven’t given up on a state that can be more humane or who are working at local levels with city councils, with commissions, with state legislatures. There’s a huge division in the country between red and blue. I don’t think it’s exactly like that, but we’re still fighting all this stuff out.

I would not give up on a state that knows how to manage things, and knows how to manage things for disabled people, that knows how to manage things for people who are working on questions of mental health.


MIA Reports are supported, in part, by a grant from the Open Society Foundations


  1. Leah, you certainly earn your pay.
    Thank you for the blog, and thank you to Mab Segrest.

    An oppressive society never works in the long run, especially for the ones who did the oppressing.

    One cannot take any solace or pride in not having been involved with psychiatry, or having a, disguised as “disorder” or “illness”, used to define their character. It is not the thing you experience or are distressed with that gets you a label, it is the fact you chose to or were dragged to an officer of the mind.

    And most likely, if you talk to someone outside of psychiatry, even they try to figure out what is “wrong with you”, based on the information someone gave to them. This turns to not listening, but trying to figure out.

    This “not listening” is the crux of the issues. Putting an end to slavery and other behaviours, never solved outcomes of the original wrongdoing, nor the original wrongdoers. Because it was not the individuals, but rather the collective of the powerful, the entitlement of believing that they were higher up on the moral or intellectual ladder.
    And we stop a practice along the way, but the crap follows us, it reinvents itself.
    And no oppressor nor complacent should feel at peace any longer, we have enough data to suggest that everyone ends up suffering under ideas, beliefs, ideals, that we subject others to, or what we believe to be others.
    It is never just those others that suffer, though it seems so on the surface.
    There might be a mass of the populace that wholeheartedly believe there are 2 forces, one being the affected, and one the oppressors or the ones who “handle” the affected. This is a belief that is falsely reassuring.

    There is no such thing as no ripple effect. Psychiatrists and jail guards included.
    It has always been insane ideas and theories that overpower the “insane”, the “disordered”. Psychiatry is the thing of today, only to be replaced by something else.
    I am a bit taken aback by studied men, who can look at history, holding on to the same paradigms, that there are such things amongst them as “idiots”, and that they should be chemically altered, to suit the present role model of humanity.
    Show me my role model, please.

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  2. Outstanding interview! And, this book is a treasure. That much is evident from the question posed to Segrest by her *very* triggered colleague, “Is your book ‘anti-psychiatry’?”. He just HAD to interrogate her motive for writing this book, despite her generous description (“I find psychiatrists doing both execrable and very commendable things . . . “) of psychiatry’s potential and despite her decade-plus of research on her subject matter. Anything that prompts this response from the establishment is right up my alley.

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  3. As a psychiatrist who has been railing against the wrongheadedness of American Psychiatry for the 45 years that I have been practicing, I am soooooooo excited, thrilled, impressed by the scholarship this interview documents.

    I have ordered the book. (From my local bookseller.)

    I have contacted my favorite American Studies scholar and hyped the book to her.

    This sheds so much new, different, and much-needed light on issues that have vexed me, and tortured the people I have tried to serve, throughout my career.

    Huge thanks and congratulations to Mab Segrest, to Leah for such an excellent interview, (a precis of the book, it seems), and to MIA for making work such as this possible and spreading the news.

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  4. I think the forced treatment (psychiatric institution) abolition movement and the chattel slavery abolition movement are intimately connected, and if we got rid of one oppressive system, we certainly haven’t gotten rid of the other…yet.

    In Virginia, Central and Western State Hospitals weren’t integrated until about 1967 or thereabouts, and primarily because of the struggle to integrate the educational system. In the Jim Crow south then, not only were swimming pools, restaurants, and schools segregated, but so were psychiatric hospitals.

    Today you have this epidemic in so called “mental health” issues because locking people up engendered an industry that can’t survive without ‘customers’. Stop locking people up, and maybe we can start “curing” some of the “service providers”, the “treatment” salespeople, the real culprits behind our current epidemic. Of course, in order to do so, it would help if we could do also something about the drug industry, an industry that also benefits from psychiatric slavery, torture and imprisonment.

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