The Racialized History of Black Mental Health in America
In 1875, a Black woman named Judy B. was admitted to St. Elizabeths Hospital in Washington D.C., diagnosed with “chronic dementia.” Though her medical file remained largely empty for decades, later notes documented her speaking to long-lost relatives and her former enslaver, as well as her attempts to “catch witches.” A white doctor at the hospital used Judy’s case to support the racist theory that Black religious beliefs indicated psychosis and racial inferiority. This disturbing case represents just one example of how psychiatry was weaponized against Black Americans in the post-Civil War era, as detailed in Judith Weisenfeld’s meticulously researched book, “Black Religion in the Madhouse: Race and Psychiatry in Slavery’s Wake.”
Medicine had long served as a vehicle for racist ideology in America. During slavery, doctors claimed that physiological differences justified the enslavement of Black people. After emancipation, the mental health of Black Americans became a fixation for white psychiatrists, who used their growing professional authority to institutionalize and sterilize Black people. Their pseudoscientific theories questioned Black people’s fitness for freedom and civic participation. As Weisenfeld explains, “White psychiatrists’ theories about Black religion and mental illness promoted claims of African Americans’ unfitness for freedom and bolstered broader arguments for political disenfranchisement and social marginalization.”
Drawing from hospital records, court documents, newspaper accounts, and other historical sources, Weisenfeld reveals how post-Civil War white society systematically portrayed Black people as mentally unstable. White physicians claimed that insanity diagnoses among freed Black people were increasing at alarming rates, often attributing these cases to “religious excitement” – a state of supposedly “excessive or disordered religious belief and practice.” White psychiatrists pathologized normal Black religious expression, categorizing it as a form of mental illness. Many of these medical authorities either owned enslaved people themselves or came from slaveholding families, bringing their deep-seated racist beliefs into their medical practice.
These physicians used their diagnoses to argue that emancipation had been a mistake and that Black people couldn’t handle freedom. A telling Richmond Times headline from 1900, summarizing a Virginia medical professor’s lecture, proclaimed “Freedom Fatal for the Negro,” with the subtitle “Insanity’s Ravages.” This racist narrative was part of a broader effort to undermine Black freedom and reinforce white supremacy after the Civil War. The psychiatric establishment became a powerful tool for controlling Black bodies and minds during this period of contested citizenship rights.
It wasn’t until Black religious leaders began challenging this white psychiatric consensus that cracks appeared in this narrative. By the 1930s, a growing number of Black physicians and psychiatrists joined this resistance, advancing the argument that racism and unequal treatment were the true causes of poor mental and physical health outcomes among Black Americans. This counter-narrative gained traction as more Black professionals entered the medical field and documented the real impacts of systemic racism on health.
The echoes of this history continue today. Weisenfeld draws a powerful parallel between the historical concept of “religious excitement” and the more recent, discredited term “excited delirium,” which has been used to explain deaths in police custody, particularly among Black men. Both terms have served to pathologize Black behavior and provide convenient explanations for deaths resulting from systemic violence. Though major medical organizations don’t recognize “excited delirium” as a legitimate diagnosis, it continues to be invoked to discount police brutality.
What makes Weisenfeld’s work particularly valuable is her commitment to humanizing the individuals whose lives were shaped by these racist psychiatric practices. Though their own voices are largely absent from the historical record, she carefully reconstructs their experiences from the available evidence. Judy B.’s story is especially poignant—a woman who spent decades confined to an institution, lost track of time, and was judged by memory tests that asked for information she may never have known as a formerly enslaved person. We glimpse her humanity through letters from her daughter Hattie, who inquired about her mother and sent fabric for a dress. Judy B. died in the hospital, her full story and experiences largely silenced by an institution and medical system that saw her primarily through the lens of racist ideology rather than as a human being deserving of dignity and care.
